What to Make of Study on Saw Palmetto?

A major part of the "business" of American health care is the sale of pharmaceutical drugs. These drugs are highly profitable for the Pfizers and Bristol-Myers of the world because they hold patents on the formulas, and thus control the prices of the items on an exclusive basis for many years. Nutritional supplements are held in much lower regard from a business perspective because they aren't patentable, and thus not subject to the same kind of pricing controls.

I always think about those facts of business life when I read media reports on some study or another that pans a nutritional supplement. The latest panning is being doled out for saw palmetto, an herb long recommended for men to prevent and/or treat benign swollen prostate. The most recent New England Journal of Medicine reports on a study of 225 men with moderate to severe symptoms of benign prostatic hyperplasia, and concludes that those who took Saw Palmetto had no more improvement than those who took a placebo.

I was curious to read the fine print in the form of quotes by various participants and observers. Forbes.com provides an excellent description of the study, and quotes by the scientists who conducted the study and other observers. I was impressed that these scientists said they tried to identify the best quality Saw Palmetto to use in the study. I was also impressed that they quoted the head of a supplement industry trade group, who generally praised the study, but incisively pointed out that Saw Palmetto is best used by men with mild symptoms of prostate enlargement, rather than with moderate to severe problems, as tested in the study at hand.

This potential problem is reminiscent of a study within the last couple of years suggesting that St. John's Wort is useless in treating depression. It turns out that study, too, was conducted on patients with moderate to severe depression, rather than the mild depression thought to respond best to St. John's Wort.

What's especially bothersome about such studies is that the media tend to give little if any attention to such inconsistencies, and instead blair out headlines that the supplement in question is "useless" or "doesn't work." We're talking here about supplements that not only have been used by many millions of people for sometimes hundreds of years, but that also have at least some supportive studies attesting to their benefits.

The same pharmaceutical drug doesn't help everyone treated, and works differently according to the severity of the condition. I know people who have serious migraine headache problems who've gotten no relief from the most powerful pharmaceuticals promising to relieve migraines. I also know there are people who have responded quite well.

Bottom line: don't take too seriously the media headlines about supplements or drugs. The same items have different effects on different people. Also remember, there are serious financial battles being fought out in the background.

Comments

[John Johnson]

I find it fascinating that a single negative study on an alternative treatment elicits such words as "useless" and "waste of money," even if other studies (however imperfect) suggests some effect.

On the flip side, I do wish that complementary/alternative medicine (CAM) researchers would adapt the preliminary safety and efficacy studies required of investigational pharmaceutical compounds. I think it would help us understand an herbal remedy better before we spend a lot of money on large trials, and cut down on the expensive studies with negative results.