In comments to this post on WRSA (and a BIG hat tip to CA for linking to us) a couple of commenters indicated that cayenne pepper, or black pepper, could be used as a topical hemostatic agent, in similar fashion to QuickClot.
So, sez I: Sweet. That’s a great find, let me jump on PubMed (which is a searchable database of most scientific papers published in the last 50 years) and find a couple of studies, and see how good black and/or cayenne pepper really is. Cause a huge bottle at Sam’s is way cheaper than QuickClot, easier to store, more likely to actually be pepper than some random stuff at an herbal medicine store, albeit harder to grow in a grid-down situation.
So I search: “black pepper topical hemostatic“. Nothing. “black pepper hemostatic”. Nothing. Then “black pepper hemostasis”. Nil. “black pepper bleeding” gives a paper that investigates whether ingestion of black pepper causes stomach bleeding, not really what I am after. “Black pepper blood” gives 37 articles, none of which discuss bleeding or the stopping thereof. Several on blood pressure, several on cholesterol, one interesting one on angiogenesis and another on remodeling of the aorta in hypertension. (And yes, I’m a medicine geek. I think that’s a good thing, given my current profession.)
As a side note, when I Google either type of pepper, there are plenty of folks who claim it works. The instructions usually say “apply black pepper and hold pressure for 5 minutes.” Folks, this is known as a confounder. The primary treatment for bleeding is 5 minutes of pressure, and it has been known to work since the dawn of time. You could apply [random substance X] and hold pressure for 5 minutes; this would fix anything but a major bleed.
But I’m starting to get irked. And this is one of my main gripes about herbal medicine. It’s very easy to say: [substance X] helps with [disease Y], if you don’t have to bring data along to prove it. The standards for FDA regulation of herbal supplements, herbal medicine, and dietary supplements, are all quite loose, and do not involve documented, scientific proof that they actually do what they say they do on the label. In fact, if you can provide proof that your [substance X] does modify the body to a detectible degree in some fashion, then it is classified as a drug, and subject to very stringent FDA requirements that will cost tens of millions to comply with. There is no motive on the part of the maker to do this.
So I can say anything I want, and because I am a doctor, someone out there will believe. “Black pepper stops bleeding”. “Black pepper makes you bleed.” “Black pepper turns you into an oversexed super-lover that makes the ladies swoon when you walk down the street.” “Vaginal secretions stop bleeding.” “Vaginal secretions make you bleed.” “Vaginal secretions turn you into an…” Well, you get the point. All of these have equal [in]validity in their appeal to authority to verify the claim.
This is NOT to say that herbal medications don’t work, or don’t have an effect on the body. The NIH has set up the National Center for Complementary and Integrative Health to apply some science to these claims. The NIH is itself heavily funded–around $30 billion–and a good chunk of that money is going to investigation of herbal meds. It’s a pretty hot research topic, and a lot of folks are pushing hard to discover which herbal meds, if any, work. And it’s not hard to understand why–most modern drugs came from herbal meds; this is, in effect, a large taxpayer funded drug discovery effort.
(As a side note, you should go here to look at the NIH’s “Herbs at a glance” which can be visited one-by-one or download the whole thing as an ebook; this gives you quick summaries of the actual science on the (fairly limited) list of herbs they review.)
So now I’m stuck. Folks say black pepper stops bleeding, but apparently no one has felt strongly enough about that to actually apply the scientific method and test that claim. Perhaps I have the wrong search string?
The active ingredients in black pepper is piperine. “Piperine hemostasis” shows two papers that indicate that piperine actually prevents platelet aggregation and clot formation; we also see in the first paper that capsacian (the active ingredient in cayenne peppers) also inhibits clot formation. Indeed both are at least as strong, if not stronger clot-preventers than aspirin, itself quite a potent platelet inhibitor, so much so that it is one of the mainstays of care for heart attacks. Oops. Now we have a problem with our hypothesis.
Redoing the above searches with “piperine” instead of “black pepper” yields nothing useful. Same with “cayenne pepper”. “Capsaicin” and “hemostasis” yields an even dozen papers that indicate that it is more likely to make you bleed than not; in fact, cayenne pepper is a stronger anti platelet agent than black pepper.
So I’m gonna say that the claim that topical black pepper and cayenne pepper stop bleeding, is not supported by any scientific evidence that I can find; indeed, the evidence that exists argues that it should make it worse.
By the way, I did happen across something interesting that is a herbal hemostatic agent, while doing this search. And the makers do indeed publish the recipe. And it has quite a bit of data behind it, including human and animal data. Should you be interested.
Assignment #1: Prove me wrong. Show me some data. Am I using the wrong search string? Looking at the wrong compound? Is it not the chemicals inside the pepper, but instead the surface of the pepper, acting as a scaffold for a clot to form?
P.S. I’m just as demanding of all the drug reps from Big Pharma that come calling. Pisses them off that free lunch doesn’t counteract lousy data.