For a little yellow flower, it's ignited a huge debate. Believe the headlines and St John's wort won't help hyperactive kids, but last week's study asks more questions than it answers. It's time to put funding disclosures in the dock.
The herb is typically used against depression and anxiety, so using it against hyperactivity and inattentiveness in children, something never tested before, does raise questions. But the small print at the end of the article raises questions about the validity of results from medical researchers heavily funded by the pharmaceutical industry, researching dietary supplements and food and reporting null results. Disclosing sources of funding in journals is necessary and not an admission of anything other than funding. But at what point do funding disclosures become conflicts of interest, and at what point do conflicts of interest turn into something that essentially undermines the science? Is there a cut-off point? If there isn't, there should be. To understand this issue we must first understand the study. Fifty-four children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) were randomly assigned to receive a daily supplement of 300 mg of St. John's wort (Hypericum perforatum) standardised to 0.3 per cent hypericin (a standard dose) or placebo for eight weeks. The researchers, publishing their results in the prestigious Journal of the American Medical Association (JAMA), found no significant differences between the groups with respect to inattentiveness or hyperactivity. Einstein once said that the important thing is not to stop questioning because curiosity has its own reason for existing. Let's follow Albert's advice and ask some questions. Why was this study was even performed, given the complex root causes of ADHD? I am not aware of any other studies that have previously linked St John's wort to ADHD benefits. (A quick search on PubMed shows no others.) And let's ask about the 'herbal' given to the children - the researchers admit that the actual dose in the supplements was less than half of what it was supposed to be, and that a higher (correct) dose may be of benefit. This is a nice admission buried in the article and missed by the consumer press. So, let me boldly summarise: they tested a product that contained reduced levels of the active compounds, a product unlike others on the shelves, but still concluded that St. John's wort is ineffective. This is unacceptable. For a wider food industry example, you wouldn't test white chocolate (which does not contain the heart healthy flavonoids) and conclude that all chocolate offers no cardiovascular benefits, would you? Disclosure In terms of disclosure, it is not a situation as simple as, "you can't question my results. I was honest and transparent with my funding, therefore my conclusions are honest and accurate." Erm, no. Scientists should not get off the hook so easily. Get the magnifying glass out and look at the small print at the end of the article. One of the researchers - Dr. Joseph Biederman, affiliated with Harvard University - discloses he has received funding from a number of pharmaceutical companies, and quite an impressive list it is. The list (take a deep breath because this will take a while) includes: Alza, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen Pharmaceuticals, McNeil, Merck, Organon, Otsuka, Shire, Novartis, UCB Pharma, Noven, Neurosearch, Pfizer, Pharmacia, the Prechter Foundation, the Stanley Foundation, and Wyeth. Add on additional funding from the National Institute of Mental Health, the National Institute of Child Health and Human Development, the National Alliance for Research on Schizophrenia and Depression, and the National Institute on Drug Abuse and you have what Oliver Hardy used to call "a nice mess". Situations like this will only fan the flames of the conspiracy theory bonfire that Big Pharma is out to get Little Dietary Supplements, but you don't need paranoia to question the conclusions of the JAMA study - this is common sense. Journals have fought hard to ensure full disclosure of funding. Indeed, JAMA has led the way and its editor-in-chief, Dr. Catherine DeAngelis, has written editorials emphasising that all authors are now required to report all potential conflicts. I applaud this and see Dr. DrAngelis' comments as the benchmark for all journals. I contacted JAMA to ask for Dr. DeAngelis' views on the St John's wort study and the issue of cut-off points, but I had not received an answer before this article was published. But regardless of the journal's stance, the damage from the recent study may already be done: People who are considering or already taking St John's wort for depression, a condition with a wealth of science to back it up, may now be questioning its overall effectiveness. The industry, particularly in the US, has widely criticised the study, but how much of that reaction has fallen on deaf ears? The lessons are there to be learnt, but only if people ask the right questions. Stephen Daniells is the science editor for NutraIngredients.com and FoodNavigator.com. He has a PhD in chemistry from Queen's University Belfast and has worked in research in the Netherlands and France.
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