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Science or snake oil: do “rescue remedies” ease stress?

Bach flower remedies, which you may know as “rescue remedy”, were created in the 1930s by the English physician Edward Bach. He produced 38 remedies for a variety of emotional states such as “for those who have fear”, “for insufficient interest in present circumstances” and “for despondency or despair”.

Bach’s therapeutic claims were supposedly based on his personal connection to flowers. He is said to have determined the therapeutic benefit of a particular remedy by the emotion he experienced while holding different flowers.

The remedies were prepared by floating the cut flower heads in pure spring water and leaving them in the sun, or boiling them, for a few hours. The resulting dilute stock was kept as a 50:50 solution of brandy and water for decanting to his patients as required.

Eighty years on, Australian companies such as Brauer and Martin & Pleasance promote these remedies for managing the emotional demands of life.

For example, Bach Flowers Remedy Rescue is advertised as a unique combination of five Bach™ Original Flower Remedies, all working on emotional imbalances associated with daily stressful situations (including “exam stress” and “Mum stress”).

The recommended dose is four drops (0.2 ml) on the tongue, providing about 5 micrograms of each flower extract. The rationale for the therapeutic effects of such small doses is that the energy from the living flower is transmitted into the water while the tincture is being made.

A review of studies evaluating the evidence for claims made by Bach flower remedies was published in 2010. All six placebo-controlled trials failed to demonstrate any differences between flower remedies and placebos.

The Bach rescue remedy is listed as a medicine on the Therapeutic Goods Administration’s (TGA) Australian Register of Therapeutic Goods (although many other Bach flower remedies are not). The listing states it contains “homeopathic ingredients” that have been “traditionally used to relieve feelings of anxiety, nervous tension, stress, agitation or despair and provide a sense of focus and calm”.

Listed medicines are allowed to make “low level” health claims and, although they are meant to hold information to substantiate their claims, unlike registered medicines, they’re not required to produce the evidence prior to marketing. Listed medicines are assessed by the TGA for quality and safety, but not efficacy.

The TGA also accepts “traditional” evidence (use for over 75 years) to support claims. However, to ensure advertising remains truthful, valid and not misleading, medicines invoking traditional claims are recommended to include a statement that the product has no backing scientific evidence. No such warning exists on the flower remedy products, despite the lack of scientific evidence.

So if a drop of something on your tongue that tastes pleasant allows you to stop and relax for a second, then you might find rescue remedy works for you. But there’s no scientific evidence for the formulation so you (and your hip pocket) might be better off sipping a nice, warm cup of tea.


This article was originally published by The Conversation. You can see the original version here.

What to tell your patients about complementary medicines


Over 60% of Australians take some form of vitamin or mineral supplement, and the complementary medicine industry in this country alone was worth around $3.5 billion in 2016. Many doctors will roll their eyes at such expenditure and possibly blame pharmacists for providing these products with a sheen of medical plausibility. But it’s worth asking what exactly the evidence is for supplements, whether there are patients who should be taking them, and what doctors should be telling their patients about them.

A new viewpoint published in JAMA lays out the evidence for vitamin and mineral supplements. It notes that the vast majority of randomised clinical trials of supplements have not shown benefits for the prevention of chronic diseases not related to nutritional deficiency. Indeed, some trials have shown harms with high doses of micronutrient supplements, including increased risk of stroke, cancer and death.

The upshot is that doctors “should counsel their patients that supplementation … provides little if any benefit,” the Boston-based authors say.

But although supplements aren’t recommended for the general population, there are high-risk groups for whom they may be a good idea, they note. These are:

  • Pregnant women, for whom 0.4-0.8mg/d folic acid is recommended for preventing neural tube defects. Supplemental iron might also be needed in pregnant women with low levels of haemoglobin or ferritin. Calcium and vitamin D supplementation may provide benefits, but confirmatory trials are needed.
  • Children who are exclusively or partially breastfed could benefit from supplemental vitamin D (400IU/d) from soon after birth, along with  supplemental iron (1mg/kg/d) from 4 months. But healthy children on a balanced diet have no need for supplements.
  • Adults over 50 may benefit from vitamin B12, vitamin D or calcium supplementation, but only if their levels of these are lower than recommended.

Clinicians should always ask about use of micronutrient supplements if patients are taking other drugs, to ensure there are no unwanted interactions. For example, vitamin K supplements could lessen the effects of warfarin, while vitamin B7 can interfere with the accuracy of troponin testing.

At the same time, it’s best to not be too judgemental of a patient’s use of vitamin and mineral supplements, given their prevalence in the general population.

You can access the Viewpoint here.