BACKGROUND:A reader asked me to review the evidence behind using flower remedies for children with autism. Known as flower essences or Bach flower remedies, they were originally developed in the 1930s by a British physician, Dr Edward Bach. He believed that illness ultimately arises from negative emotional states and energy imbalances. He claimed to identify 38 negative emotional states and developed 38 corresponding remedies. Many other remedies are now available.
The remedies are made by one of two methods. The sun method collects wild flowers when they are covered in dew and soaks them in spring water. The other method boils the plant material for 30 minutes. For both, the plant material is filtered to leave very dilute solutions to which alcohol is added as a preservative. The remedies are not said to work via any physical substance, but due to non-physical “energy” or “vibrations” captured from the flowers. Probably the best known product is Rescue Remedy, made from five flowers and said to prevent panic and irrationality during stressful situations.
EVIDENCE FROM STUDIES
The philosophy underlying flower remedies is focused on emotions, and these are clearly involved with autism. Flower remedies are said to permit autistic children to communicate better and handle stress better. Internet sites promoting flower remedies give numerous case studies. These document the challenges of caring for children with autism and describe beneficial effects noticed after using flower remedies.
The Flower Essence Society, a US-based organisation, funds research in this area, but does not mention any studies with autism. Its website highlights one study involving 12 depressed patients. Beneficial effects were found after they took individually prepared flower remedies for three months. However, 65 different remedies were used and the study did not have a control group. The researcher himself stated that this means the results may have “nothing to do with flower essences at all, but were merely a reflection of the sincerity and increased enthusiasm of the practitioners”.
This is why randomised controlled trials are necessary to show if an intervention is truly effective. A 2010 systematic review identified all such studies of flower remedies. None involved autism, but one included children with attention deficit hyperactivity disorder (ADHD).
No significant differences were found between the flower remedy and placebo. Another five studies investigated flower remedies for the relief of anxiety or stress. They all found flower remedies to be no more beneficial than placebo.
PROBLEMATIC ASPECTS
The flower remedies themselves have not been reported to cause problems. However, internet sites that promote flower remedies for autism invariably include strong criticism of the measles, mumps and rubella (MMR) vaccine. The connection between autism and the MMR vaccine has been shown to be a fabrication, with several independent reviews failing to find any connection.
The alleged connection between the vaccine and autism can be traced to a 1998 Lancet publication which reported on 12 cases involving autistic children. In 2010 its lead author, Andrew Wakefield, was found guilty of dishonesty by the British General Medical Council and struck off the medical register.
Since this publication, vaccine usage in the UK has dropped dramatically and measles is on the rise. Flower remedy websites that continue to claim autism is linked to vaccines could contribute to further harm.
RECOMMENDATIONS
Flower remedies have become very popular and part of a thriving business. Their extreme dilution means that they are unlikely to cause any direct harm. However, if they divert people away from appropriate medical care and effective therapies, indirect harm could occur.
Parents of autistic children face many challenges. Conventional medicine is very limited here, but any remedy or therapy should be able to provide clear evidence of benefit.
Several conditions with an emotional component have failed to show beneficial effects from flower remedies. If autistic children benefit from the placebo effect, that would be great – but then such remedies should not claim to be more than a placebo or cost any more than one.
Dónal O’Mathúna has a PhD in pharmacy, researching herbal remedies, and an MA in bioethics, and is a senior lecturer in the School of Nursing, Dublin City University
