Botanical samples are often freeze-dried (lyophilized) for use in research studies, and a variety of freeze-dried botanicals are marketed to the public. In both instances, there is an underlying assumption that freeze-drying properly preserves the medicinal qualities of plants, and is superior to other preservation methods. In fact, little systematic research has been done to verify this assumption. A review of the existing research, done primarily by the food and spice industry, indicates that freeze-drying has unanticipated and significant effects on the constituent profiles of medicinal plants that puts into question whether freeze-drying necessarily is the best method to preserve botanical medicines. This research review finds there is insufficient information to conclude that freeze-drying has negative effects on the medicinal qualities of plants. But, because existing research indicates that freeze-drying imperfectly preserves important classes of medicinal compounds (such as volatiles, phenolics and carotenoids), may increase the mutation rate in unicellular organisms and may diminish some medicinal plant actions, researchers and practitioners should carefully consider how the use of freeze-dried material may affect pharmacological and clinical study results.

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Milk thistle (Silybum marianum) is an herb that is increasingly used in oncology research and treatment settings. Historically, it has been used to treat liver and biliary disorders and has been used in detoxification and cleansing protocols. However, milk thistle is increasingly being investigated for its use in adult and pediatric populations for oncology indications. Possible indications during cancer treatment include cleansing and detoxification after chemotherapy, preventing hepatotoxicity during chemotherapy, treating hepatotoxicity after chemotherapy, and potentiating chemotherapy and radiation therapy as an adjunctive treatment. Milk thistle (Silybum marianum [L.] Gaertn., plant family Asteraceae) seed is an herb commonly used by Western herbalists and naturopathic physicians to treat liver disorders in adults. The German Commission E currently recommends its use for dyspeptic complaints, toxin-induced liver damage, and hepatic cirrhosis and as a supportive therapy for chronic inflammatory liver conditions. 1 However, milk thistle is increasingly used in research and clinical practice in adult and pediatric populations in the oncology setting. It is being used for detoxification after chemotherapy, as a hepatoprotectant during chemotherapy, as an adjunct to cancer treatment, and to ameliorate long-term effects of cancer treatment. Researchers are actively investigating its role as a chemopreventive agent and possible treatment of cancer.Much of milk thistle's current clinical use is based on recent research on the actions of silymarin, milk thistle's flavonoid complex. The plant in its whole form, however, has a long history of use that has not been fully explored. In its native Mediterranean region, it has been used for liver ailments since the Greco-Roman era, and today it remains in folk use as a digestive aid, aperient, anti-inflammatory, antineoplastic, hypotensive, styptic, diuretic, and general tonifier.2 Other confirmed folk applications include its use for pruritus, hemorrhoids, colic, malaria, and psoriasis, and as a galactagogue.3 Milk thistle traveled to North America with the Europeans and was used by North American physicians to treat gallstones, vomiting in pregnancy, amenorrhea, uterine hemorrhage, hematuria, painful dysuria, and congestion of the liver, spleen, or kidneys. 2One of the more recent directions of milk thistle research is its use in oncology. Silymarin and silibinin (1 of the components of silymarin, also called silibin or silybin) have been evaluated for their ability to exert direct cytotoxic effects, mitigate toxicity of certain anticancer agents, and enhance the efficacy of chemotherapeutic agents. Milk thistle is increasingly used as an adjunct treatment for many types of cancer, with recent research also suggesting cancer prevention applications.In this article we describe current and potential clinical applications of milk thistle in the oncology setting. Milk thistle use is usually based on historical indications. Very little clinical research has been conducted in ...

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Researchers examining the efficacy of medical procedures make assumptions about the nature of placebo. From these assumptions they select the sham interventions to be used in their trials. However, placebo is not well defined. A number of definitions are contradictory and sometimes misleading. This leads to problems in sham-controlled studies of medical procedures and difficulties interpreting their results. The author explores some of the contradictory definitions of placebo and assumptions and consequences of these. Principal among these is the assumption that the placebo is inert when it is not, which introduces bias against the tested medical procedures and devices. To illustrate the problem, the author examines the use of sham procedures in clinical trials of the medical procedures surgery and acupuncture in which the sham was assumed to be inert but was not. Trials of surgery and acupuncture should be re-examined in light of this.