Shutting the stable door after the horse is stolen

On November 6th someone anonymously commented twice on my post from October 2, 2012 titled Rock Water: the Bach Flower Remedy for perfectionism that doesn’t contain any flowers. He (or she) said that I should have tried the flower remedies before writing skeptically about them. But, I already wrote that post over three years ago, and I’m not going to apologize now for doing it. In three previous posts I had already discussed the lack of evidence for effectiveness of the flower remedies.

That comment is just shutting the stable door after the horse is stolen, a proverb shown above in a cartoon adapted from one back in 1884. It is a pointless form of heckling.

Rock Water: the Bach Flower Remedy for perfectionism that doesn’t contain any flowers

Logically, shouldn’t something called a flower remedy or essence contain some flowers? Well, logic or science doesn’t really have much to do with Bach Flowers - they’re a mystical system. (Harriet Hall discussed them on May 22nd in a post at the Science-Based Medicine blog). 

Nelsons Bach has a slick three-part video at YouTube called Bach Flower Remedies: The Journey to Simple Healing that describes where they came from. See Part 1, Part 2, and Part 3.

In Part 2 they say that:

“Most of the remedies were made from flowers, with the exception of Rock Water, which was potentised in 1933 using water from a forgotten spring.”

On page 162 his book Bach Flower Remedies form and function Julian Barnard describes more about preparation of Rock Water:

“Rock Water is not a flower remedy in the strict sense of the phrase: it is not made from flowers. Rock Water, said Bach, should be taken from any well or spring ‘which has been known to be a healing centre and which is still left free in its natural state, unhampered by the shrines of man’. Later he modifies ‘healing centre’ to having had ‘healing power’. Water from the spring is taken in a thin glass bowl and set down nearby  so that it may receive clear uninterrupted sunshine. That’s it, that’s all. The water is cold and condensation immediately forms on the outside glass. After some time the condensation clears as the water in the bowl warms. Later the familiar bubbles appear and the winking, spectral colours grow stronger until the essence is made. Bach said this remedy only needed about half an hour although Nora Weeks speaks of three hours: she erred on the side of caution.”

The Nelsons Natural World web page about How the Remedies are Made calls this first step the Sun Method (except there it also calls for flowers). In the second step that ‘potentised’ water is mixed with brandy to make a Mother Tincture. In the third step  27% grape alcohol is added.   

So, Rock Water simply could be described as spring water and brandy, and might as well be acronymed as SWAB. In modern medicine clinical trials compare a drug with an inert substance (a placebo), and neither the doctors nor the patients know who got which remedy. Rock Water would be described as a placebo.

If we look at Amazon.com for a product description of Rock Water, we find:

“Active Ingredients: 5x dilution of Aqua petra HPUS

Inactive Ingredient: 27% alcohol

Directions: 2 drops in water and sip at intervals or add to a 30 ml mixing bottle containing water. Take 4 drops a minimum of 4 times a a day. Do not use if seal is broken. Keep out of reach of children. If pregnant or breast-feeding, ask a health professional before use. For relief of naturally occurring nervous tension. Helps you to enjoy life’s pleasures rather than stick to rigidly to your ideals or personal habits.”

The abbreviation HPUS means Homeopathic Pharacopoeia of the United States, and Aqua Petra is a fancy Latin phrase for spring water.

What they’re selling us is water and alcohol - to take dissolved in more water. At $17.54 for 20 ml, that’s an extremely expensive $877 a liter. (Compare that price with any vintage wine or liquor). 

Reading Julian Barnard’s description reminded me of an infamous comedy sketch from Monty Python’s Flying Circus, in which John Cleese encountered a Cheese Shop completely devoid of cheese (and eventually resorted to senseless violence). There is another sketch called Crunchy Frog in which the owner of the Whizzo Chocolate Company is taken to task for inadequate descriptions of his products.

Does the mimulus Bach flower essence (or remedy) reduce anxiety?

Some people believe that the best remedy for overcoming fear of public speaking is preparation and practice. Others look for shortcuts in alternative and complementary medicine, such as Bach flower essences (or remedies). Back in January 2010 I blogged about flower remedies and a trial of one combination called Rescue Remedy.

Mimulus is another flower essence prepared from a single type of yellow flower, as is shown above. Sara Radcliffe explained that:  

“Mimulus is for those who have specific fears about things, people or events. This includes anticipatory anxiety such as fear of failing an exam or fear of how things will turn out, or fear of poverty as well as phobias such as fear of public speaking, fear of dogs, fear of robbers and so on.”

There is a three-minute video about mimulus with pretty music and images posted on YouTube. But, is there any evidence that it works? I couldn’t find a double-blind trial for  mimulus alone.

However, back in 2001 Harald Wallach, Christine Rilling, and Ursula Engelke published a an article in the Journal of Anxiety Disorders titled “Efficacy of Bach-flower remedies in test anxiety: A double-blind, placebo-controlled, randomized trial with partial crossover.” You can read an abstract here. They looked at a combination of ten remedies containing mimulus and also impatiens, gentian, chestnut bud, rock rose, larch, cherry plum, white chestnut, scleranthus, and elm. Their study didn’t find a significant effect above that of the placebo. If any of those ten remedies were effective it should have. Nevertheless, in 2008 Nelsons issued a press release titled Flower Power + Brain Power = Exam Success.

The image of mimulus came from Wikimedia Commons.

Bach Rescue Remedy and anxiety

On January 15th yet another superficial article All About Bach Rescue Remedy was posted. It is a trademarked combination of five flower remedies (or essences). Rescue Remedy has been recommended as being useful for reducing anxiety, including anxiety about public speaking or taking exams. The article contains a paragraph headlined: Scientific Support for Rescue Remedy which includes the following statement:

“….However, in 2007, a study by the University of Miami Nursing School in conjunction with The Sirkin Creative Living Center declared that Rescue Remedy ‘is an effective over-the-counter stress reliever with an effect similar to that of traditional pharmaceutical drugs.’ The study added that, unlike traditional stress medications, Rescue Remedy had no adverse side effects and was not addictive.”

The link provided about the University of Miami study just was to a re-issued press release from the US subsidiary of Nelsons (who make Rescue Remedy). You can also read the press release here.

The press release is more positive than the 2007 magazine article describing the details of the study. If you go to the Sirkin web site you can find the full text for Healing With Bach Flower Essences: Testing a Complementary Therapy as an Acrobat file.

As shown above in the diagram, they looked at a sample of 111 nursing students, and compared the effect of a placebo (58 students) with Rescue Remedy (53 students). They did not find a statistically significant difference in test anxiety after receiving the placebo or the remedy.

Then they split the sample into three subgroups based on their state of anxiety before the students received either the placebo or the remedy. When they analyzed the differences for the subgroups, as shown below in the diagram, they did find a statistically significant difference for the subgroup with high anxiety (but not for either low or medium anxiety). The abstract of the article concludes with this statement (my capitalization):

“The results SUGGEST that BFE Rescue Remedy MAY be effective in reducing HIGH levels of situational anxiety.”
















If you look for an independent review of Bach Flower Remedies on the web sites of some medical centers, you will find an article from Ebsco here, here, and here. Their discussion of the data analysis in the 2007 article says:

“However, after the study was concluded, researchers then explored the data, and found a relative benefit in one subgroup of participants. This may appear to support the use of Rescue Remedy. However, such ‘post-hoc’ statistical analyses are notoriously unreliable: based on the laws of chance alone, it is almost always possible to find some subgroup that showed benefit in a study. The process of doing this is called ‘data dredging,’ or sometimes, ‘going on a treasure hunt.’ Such investigatory analyses of data can provide fodder for future studies, but they make no positive statement about the results of a study already conducted.”

Read the original magazine article, and then make up your own mind. Don’t just get your information from a press release.

Flower remedies or essences for anxiety?

Many people are aware that preparation and practice are the best ways to reduce anxiety about public speaking. Some instead look to complementary and alternative medicine for a quick fix.

One therapy that has been recommended is the Bach flower remedies(or essences). More specifically, a trademarked combination of five flower essences, called Rescue Remedy, often has been described as being good for reducing anxiety about tasks like public speaking and taking exams.

Is there any solid evidence, like double-blind clinical trials, which shows that flower remedies actually are effective for reducing anxiety? (In a clinical trial the experimental treatment is compared with an inert placebo to see if there is a statistically significant difference in the results.)

Last year Thaler et al published an article in BMC Complementary and Alternative Medicine which discussed Bach Flower Remedies for psychological problems and pain: a systematic review. Thaler et al review three clinical trials of flower remedies for anxiety by students about taking examinations (test anxiety). There were two trials done in 2001. One used a five-flower remedy, and the other used a ten-flower combination. There was another trial done in 2007 which used the trademarked Rescue Remedy. You can read a summary in Table 3 of their article. No statistically significant difference was found in any of these studies. Based on these results Thaler et al concluded that there was no evidence that flower remedies were effective.

In 2004 Jorm et al published a broader review in the Medical Journal of Australia which discussed the Effectiveness of Complementary and Self-Help Treatments for Anxiety Disorders. They also reviewed the two trials of Bach flower remedies done in 2001, and concluded there was no evidence that flower remedies were effective.

Read these two serious review articles, and then make up your own mind about flower remedies or essences.