Here, Jerome Burne is given space on Patrick Holford’s blog to defend homeopathy by attacking drugs that are part of conventional medicine.
I want to focus on the discussion of SSRI drugs for depression, but first I will briefly comment on a couple of the other aspects of the article.
Firstly, there is the attempt to criticise an evidence check on homeopathy (a report of the commons Committee on Science and Technology specifically addressing homeopathy) for “not going far enough” and tackling non-homeopathic medicines that the author takes issue with.
Secondly, there is the conclusion to the article:
So there is nearly £300 million being spent on drugs with serious questions marks hanging over them. Is bringing the big guns to bear on homeopathy, which certainly never harmed anyone, really the best way to cut our drugs bill?
The italics are mine, the omission is Burne’s – he neglects to address the indirect harms caused by homeopathy. The misleading of patients who are entitled to expect to be fully informed of the nature of remedies in order to give informed consent is one indirect harm.
Another is rather more serious – the potential for respectability to be conferred upon homeopathic remedies by what might be seen to be NHS approval of this alternative medicine. If homeopathic medicines are seen as efficacious, we might expect to see more of this: What’s The Harm?
Thirdly, the title of the Burne article is sheer class. “Save NHS money on ineffective drugs, not homeopathy” implies, after all, that we should save money on drugs that sometimes actually work – and leave the demonstrably ineffective homeopathic remedies alone.
Surely “Save NHS money on ineffective drugs and homeopathy” would have made more sense?
Serotonin Pills, Money, Evidence, Holford, and Burne
Burne writes, of a study of SSRI anti-depressants, that:
it found that these drugs were only effective when given to the relatively small number of people with severe depression. For the millions of others taking them they were no better than placebos.
While I am pleased to see that Jerome Burne is writing – on Patrick Holford’s website – about the value of treating mild to moderate depression with pills, it is worth noting that Patrick Holford has himself promoted pills for depression.
While criticising the evidence check for focussing on homeopathy and ignoring conventional drugs, Burne himself concentrates on SSRIs and ignores remedies such as tryptophan and 5-hydroxy tryptophan (5-HTP). Burne also begins each paragraph with a note on the amount spent on each drug he criticises.
Patrick Holford, a popular writer and founder of the Institute for Optimum Nutrition (ION), recommends in one of his books (Optimum Nutrition for the Mind) the following:
St John’s Wort 300mg 0.3% hypericin, to be taken 2-6 times daily, making that a total intake of 600-1800mg at a cost of 15p per capsule – which means you could be paying from £2.10 up to £6.30 per week (or £9 to £27 per month).
Holford also recommends 5-HTP at 200-600mg daily – costing up to 28p for a 100mg pill. Assuming that one buys the larger pack at 26p per pill, this would cost between £15 and £50 per month. The two together could cost almost £75 per month.
Given Jerome Burne’s enthusiasm for studies looking at whether a treatment has a benefit beyond placebo and his concern at money being wasted on ineffective treatments, I would be interested in his thoughts on the use of 5HTP and St John’s wort as alternatives to SSRI anti-depressants.
Here’s some evidence on 5HTP and St John’s wort:
Further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia-Myalgia Syndrome has not been elucidated. Because alternative antidepresants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present. [Cochrane review of 5-HTP / Tryptophan.]
The Cochrane review of St John’s wort seems more optimistic:
The available evidence suggests that the hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants. [Cochrane review of St John’s Wort.]
Although there are some notes of caution sounded in the paper. For instance: “The association of country of origin and precision with effects sizes complicates the interpretation.” I wrote a blogpost about the association of country of origin here: Cultural Bias in Scientific Research.
The authors of the Cochrane review of St John’s wort also note that:
St. John’s wort products available on the market vary to a great extent. The results of this review apply only to the preparations tested in the studies included, and possibly to extracts with similar characteristics. Side effects of St. John’s wort extracts are usually minor and uncommon. However, the effects of other drugs might be significantly compromised.
I look forward to reading Jerome Burne’s thoughts on the evidence relating to 5HTP and St John’s wort, and the cost to the consumer of purchasing these remedies.
Holford’s conclusion at the end of the chapter on Overcoming Depression begins:
In summary, if you are experiencing chronic or severe depression:
See a clinical nutritionist who can check for any biochemical imbalances, and devise a nutritional programme to improve your mood. This may include supplements of St John’s wort, 5HTP…