Ethics of Ginkgo Biloba Revisited

A little over a year ago, I blogged about the current state of evidence regarding the effectiveness of one particular herbal remedy: Ginkgo Biloba a Dud for Alzheimer’s: Ethical to Keep Selling It? I noted that there was little good reason to think it an effective remedy, and suggested that, as a result, it was ethically problematic for companies to keep selling it.

Just yesterday, Scott Gavura at the Science-Based Pharmacy blog, posted an important update on the evidence regarding Ginkgo Biloba: Forget to take your Ginkgo biloba? Turns out, it doesn’t matter. Gavura’s posting is based on a new study reported in a recent issue of the Journal of the American Medical Association. Gavura (a licensed pharmacist) notes that he was once guardedly optimistic about Ginkgo Biloba, But given the most recent science, he says that hope is gone:

The largest and best-designed study to examine Ginkgo biloba has found it ineffective in reducing the incidence of dementia, Alzheimer’s disease, or in reducing the rate of cognitive decline in older adults. This is a persuasive study. In a population that is very close to the “real world” that might consider taking the product, no effect of ginkgo has been shown.

Importantly, Gavura ends with this ethical prescription:

It’s time for pharmacists to start recommending against self-treatment with Ginkgo biloba for the treatment or prevention of dementia or cognitive decline. [His emphasis.]

I agree. And it’s worth noting that the ethical constraints on pharmacists are stricter than the ethical constraints generally imposed on companies. Pharmacists are granted a collective monopoly on a particular field of practice, and we trust them to advise us on complicated matters that are deeply important to us. So, when supplement companies insist on their freedom to sell Ginkgo Biloba, on the very thin grounds that, hey, after all, people want it, it falls to pharmacists to do what they can to keep the public from wasting money on product that, while once promising, we now know to be useless.

5 comments so far

  1. Wesley Gee on

    Hi Chris,

    We should be able to buy something that will not hurt us, so long as the ginko companies are not making claims for their products that are not scientifically substantiated- in which case they will likely be able to reference studies which are contrary to these recent results.

    If we are able to sell products that indeed hurt people while offering some level of personal satisfaction – e.g. cigarettes – it would seem rather hypocritical to remove products that pose no harm to people. The issue is not the product, but how it is and will be marketed to consumers.

    Wesley

  2. Chris MacDonald on

    Weskey:

    Thanks for your comment.

    GB is, to the best of my understanding, marketed for a specific use. It’s not just sold randomly. So the people selling it need to be able to provide some evidence.

    And, importantly, I think they need to be able to do something better than just point to a study. If they’re going to use science, they need to do it right, which means pointing to the preponderance of evidence, from well-designed and well-run studies. From what I understand, the preponderance of evidence is that GB simply has no effect on memory decline.

    Chris.

  3. DarryleHuffman on

    One must also remember that herbal remedies do not fall under the same guidelines as penicillin or some other drug the pharmacist sells.

    I do have some home remedies I take but these do work.

  4. Chris MacDonald on

    Darryl:

    You’re right, in most places the legislation covering herbal remedies is much more lenient. That’s generally unfortunate. If a product claims to affect how your body functions, it should a) be proven effective and b) be proven safe. That’s almost never the case for herbal remedies.

    As for whether the herbal remedies you take actually work: very few have been proven effective. Scott Gavura’s blog is a great source of information in that regard.

    Chris.

  5. […] Ethics of Ginkgo Biloba Revisited January 3, 2010 […]


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