Question:
the one thing I think may be effective in hepatitis C that Ido use regularly is silymarin or milk thistle. That's an alternativemedical therapy for you! And it is one with some clinical studies tosupport it.

Answer: There is actually quite a lot in the convential medicalliterature on Milk Thistle (Silybum marianum) and Liver disease and aMedline or Pub Med search will yield a numnber of articles.

There is a good review article by Kenneth Flora et al out of the Divisionof Gastroenterology at the Oregon Health Sciences University in theAmerican Journal of Gastroenterology volume 93, No 2, 1998, page 139-143entitled Mile Thistle(Silybum marianum) for the Therapy of Liver Disease.This review a number of clinical trials.

Another interesting paper is in the journal Alternative Medicine Alertentitled Mil Thistle for Treatment of Acute Hepatitis, Chronic Hepatitisand Cirrhosis by E.P. Barrette, M.D. on page 113-115, October 1998. Hepoints out that there are positive studies in alcoholic hepatitis andcirrhosis showing improved transaminanse levels and mortality but thatthere are no published controlled trials in hepatitis C. He indicates thatthere may be a controlled trial ongoing at Cedars-Sinai.

Now, my totally anecdotal experience of two patients on milkthistle who are not on interferon - LFT's have fallen as well as viralloads by Hep C RNA PCR. I can't get either of these patients to stop itnow so I can't see if the viral load will go back up. And I'm not in aposition to perform a double blind placebo controlled trial. I hopesomeone does. In the meantime, I suggest it to my patients and followthose I have on it.

For those of you out there who believe in alternative medicinenot conventional medicine, this saga illustrates some of the pitfallswe currently face. Because this supplement is so available and themanufacturers can make an enormous profit without any investment inresearch, no one will do the studies to see whatthe appropriate dose is, how long to take the drug etc. So we don'treally know what the best thing to do is. I know some of you dislikepharmaceutical companies but I'm still waiting for Nature's Resource orNatural Life or one of the other supplement companies to fund anappropriate trial. In the meantime, many patients elect to take thissupplement based on what few trials have been done by independentinvestigators.