FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SAW PALMETTO NO BETTER THAN A SUGAR PILL FOR PROSTATE PROBLEMS

Question: I've enclosed an ad for saw palmetto, a non-prescription medicine that may ease my prostate problem. It appears that I can use this product without harm, at least that is what the ad and my urologist say. What I need to know is will it do any good? Is it efficacious? My urologist wouldn't address my questions about its value.

Answer: I receive many letters about similar concerns. That is, can one believe the health claims made in advertisements for vitamins, herbs, medicines and other health-related products. There has been an increased effort to directly market this type of item to you and me, including an interesting trend to advertise prescription drugs to individuals with advice to "speak to your doctor."

Despite federal rules about truth in advertising, it is wise to be skeptical about information in any ad. Remember, the advertiser only makes money by selling its product. Therefore, the product is represented in its very best light. Spokespersons have views that are strongly biased by the source of their pay check and, occasionally other reasons, but they don't represent an even-handed evaluation. The advertising for saw palmetto, a plant extract that is claimed to reduce symptoms of enlargement or chronic disease of the prostate (prostatism) that often afflicts men over 50, is a good example.

The ad uses the current popular words "natural" and "herbal" to promote a general acceptance of its worth and safety. A great choice of words by the ad copy writer, but they really tell you and me nothing of importance. There are many "natural" and "herbal" plants out there that are far more hazardous to our health than "synthetic" or "artificial" products. So ignore the emotional response and search for the facts.

I can find no literature in the National Library of Medicine Medline database about benefits or hazards from saw palmetto. This means that the clinical studies quoted by the advertisement were sufficiently inaccurate that they weren't published in a credible peer-reviewed journal. In other words, it wasn't worth the paper it was printed on!

This doesn't mean that saw palmetto is without benefit, however. Since this product can't be patented, no drug company is willing to spend the millions of dollars necessary to do studies that would prove its usefulness because they can't recover their investment from exclusive rights to sales.

Saw palmetto claims to work by inhibiting the production of a hormone, DHT, which promotes prostate enlargement and the resultant symptoms of prostatism. If this is so, it is safe to assume that the real benefit from taking it is very small. You see, there is a prescription medication that works in the same way but is much stronger than saw palmetto. The drug was promoted with much fanfare when it first went on sale several years ago. Additional careful studies since then have shown it has only modest benefit in a very select group of men.

I think that it is safe to assume your urologist just didn't want to be quoted, but I will. Any benefit for your prostate from taking saw palmetto is likely to be no greater than you would expect from taking a sugar pill (i.e., a placebo).

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.