Editorial: A Small But Significant Victory

By Len Monheit

Cause and Effect, action and reaction – it’s nice when you see the lines connect.

It doesn’t really happen that often in the world of business, even with advertising, unless you’ve developed a really clear and measurable campaign with each component separately measurable. In most cases, though, identifying how effective each contributing factor was to the program can be a challenge.

Let’s switch gears for a moment. Industry’s war to achieve credibility has been a long and tiring one, dating from (or certainly accelerating since) the passage of DSHEA. Many of the battles, most will confess, have been a loss, or stalemate at best, especially if you consider the measurement to be media coverage. And for a variety of reasons, in the short to mid-term, that is not likely to change.

There are however other measurements and other battles. Some take place totally behind the scenes, others in dialogue with regulators as policy gets developed and regulations get planned. Still other battles are visible with legislators and other policy forming groups. And then there are the battles with those who influence research and science and the communication of that research. It’s long been apparent to me that those who write and present the results really have all the power – they determine the legacy, so any influence that can be developed over those doing the result writing has a powerful effect on what story gets told – that’s one of the reasons why media itself is so important.

A few months ago, the herbal sector was rocked with a study, published in the New England Journal of Medicine (July 28, 2005), which described the use of a low dose of Echinacea angustifolia root, determining that this dose was ineffective in helping to treat or prevent cold symptoms. In many of the media representations of this study, all doses of Echinacea were labeled as ineffective, and, distressingly, this approach was taken by The National Center for Complementary and Alternative Medicine (NCCAM), as it described the results, in fact specifically noting that the study as “well-designed” and the low-dose used as “internationally recognized.” Or so the NCCAM website read until this week.

Last week, the American Herbal Products Association (AHPA) sent a letter to NCCAM director Stephen E. Straus, M.D. requesting that inaccurate and inappropriate statements on the NCCAM website, dealing with the study, be revised. Specifically, in the context of this particular study, AHPA objected to the use of the statement “what’s on the label may not always be what’s in the bottle.” Other issues included creating the impression that the dose was appropriate, and NCCAM statements, picked up widely in the media, suggesting to ‘stop attributing any efficacy’ to Echinacea. In its communication to NCCAM, AHPA asked for the website to be revised and for corrective statements to be issued to the media. And NCCAM responded – in part.

As of earlier this week, the NCCAM website (http://nccam.nih.gov/clinicaltrials/echinacea_rr.htm) has been revised, including the addition of a comment that “critics of this study believe the dose of E. angustifolia used was too low” a direct response to the communication from AHPA. There has been no indication that corrective statements have been issued to the media, and it is unfortunate both that this is unlikely to happen, and that even if it did, the media would not be all that interested.

Was the exercise and effort worthwhile – absolutely. Did it achieve all of its desired outcomes – no. But it challenged (and changed) the legacy of the study, a key aspect. It may influence the course of future research and future references and study citations by placing an asterisk by the study, certainly for any that reference the NCCAM website.

Left unchallenged, both the NCCAM site and comments would have become virtual truth, in the absence of another point of view and head-on challenge. AHPA’s approach, and similar messaging from the American Botanical Council immediately after the study was published might seem like too little, too late, and too ineffective in a wider consumer or media environment, compared to the media furor which surrounded the initial release, but getting the challenge on the record, formally, and impacting the ‘legacy’ are critical elements of industry’s efforts to defend itself from its detractors.

Bringing us back full circle, battle has been waged, on a small scale, and victory achieved. And AHPA can show a rather immediate cause and effect relationship between the letter it issued to NCCAM and the changes to the NCCAM website – ‘legacy’ changes.

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