04.The bottom line
The lack of transparency we encountered would be unacceptable from manufacturers of conventional medicines. Even in this industry, though, there have been well publicised cases of pharmaceutical companies deliberately withholding research findings from public scrutiny - and, indeed, from licensing authorities - leading to actual or potential serious health problems for people taking the drugs. Fortunately, these cases appear to be uncommon, and when discovered can result in a financially devastating backlash.
Unlike many other complementary healthcare products, there's good evidence for the effectiveness of St John's wort as a treatment for mild depression. When we started this story we thought we'd be able to present you with a thorough assessment of the products on the market and make clear recommendations as to which ones are the best. Due to the constraints on testing the contents of SJW products and the lack of transparency about evidence for their products' efficacy shown by some manufacturers, all we can now say is that the evidence for the claims made by the six brands of SJW (see Evaluating the evidence
) is convincing. What we can't tell you is whether any or all SJW products contain what the labels say they do.
If herbal medicines are going to be taken seriously in the general and medical communities, it would be in the interests of consumers as well as those sponsors that make or distribute genuinely effective products if the guidelines for evidence were clearer, tougher and more rigorously enforced. Then the public could be sure that the TGA is regulating effectively, and that the complementary medicine products they're buying are worth the money.
In the final stages of putting this article together, the government announced an overhaul of the regulatory regime for complementary medicines, to take effect at an unspecified time in the future, including a crackdown on the claims being made. Sponsors will then be required to provide the TGA with a summary of evidence, and the TGA will increase its monitoring of the evidence.
At present, though, as a consumer you'd be mistaken if you thought you could buy any formulation of SJW at random and be assured that it works, and that the company has clear evidence that it works. The regulatory system is failing to adequately protect consumers, and also failing to protect those members of the industry who are doing the right thing. In the case of SJW, where there's good evidence of its effectiveness as a treatment for mild depression, this is a real shame.