Herbed and Perturbed

Regarding Tom Danehy's "Flower Power" (July 26), it isn't news that entrenched interests will continue to deride all herbal medicine as foolish or dangerous. But what good is served by using these people to pick up where the 60 Minutes hatchet job left off? If we believe only these people, and not give due diligence to the flow of millions or billions of dollars into congressional coffers by the pharmaceutical companies, or the systematic attempts at gutting patients' rights by the GOP, we are completely missing the point.

Sure, there is importance in making sure dosages of herbal remedies are accurate and their contraindications explored. But the fact that they haven't been, and why, is only hinted at instead of featured as it deserves to be. By purposely avoiding, denying or blocking this critical research, Big Medicine/Big Pharma achieves two goals. The first is to feed the doubts of those worried about undesired effects or wasted money on less-than-claimed levels of active ingredients. The second, however, is far more devious. Such research would undoubtedly reveal as-yet poorly documented connections between herbal remedies and healing, and of significant capacities of the mind-body connection to our health.

Much of this territory is clearly served better by herbal and other alternative approaches. This is exactly the system Big Medicine intends to replace, and which has historically served us for all time--I repeat, all time, not just the last hundred years or so.

If we negotiate away all reason in the quest for balance, honoring naysayers with an undue authority over observable fact, we are, quite simply, lost. This is exactly what Tom Danehy did. This is both unfortunate and dangerous.

Herbal remedies, on the other hand, continue to work with far better efficacy, fewer side effects, and without creating widespread disruption to our ecosystem, our gene pool, our economy and the collective bank of cultural knowledge Big Medicine seeks desperately to mine for all it can steal. I paraphrase Dwight Eisenhower when I say, "Beware the medical industrial complex."

--Tony Novelli
Assistant Director
Development Center for Appropriate Technology

To the Editor,

If, as you claim, herbs are useless, then why, according to the World Health Organization, are over three-fourths of all modern medicines synthetic copies of natural compounds found in herbs and other medicinal plants?

For example, one common modern medicine, aspirin, is a synthetic copy of White Willow bark (or Meadowsweet), replicated in artificial form to obtain the medicinal effects of salycylic acid, which is found in these herbs. Aspirin is taken every day by thousands, if not millions, of people. It is a common household medicine, clearly derived from an herbal medicine.

I have used herbs for many years, and I can attest to their healthful benefits. If herbs are so useless, why are more and more doctors beginning to study them? I know of several doctors locally who use herbs and modern medicine side by side, with good effect. Your article was misinformed and inaccurate, and dismissed thousands of years of tried-and-true natural medicine out of hand.

--Andrew Brooks

To the Editor,

Daheny's article on herbal supplements only shows how completely he buys into Dr. Knope's mindset. He never brings up the main thesis in Dr. Weil's message--that the ultra-conservative Western medical establishment has ignored Eastern and folk medicine, from which it has much to learn. He also recommends that the individual take responsibility for his/her health in the meantime.

Let's look at the most sensible quote in Daheny's article: "In the best kind of medical practice, all proposed treatments must be tested objectively" (Dr. Arnold Relman, former Harvard teacher of Dr. Weil and former editor of The New England Journal of Medicine). Weil's point has always been that the medical establishment has been disregarding folk and herbal treatment out of hand. They simply could not be bothered with researching folk and Eastern remedies. Thanks to Dr. Weil and others like him, Western medicine is beginning to do that research. Three cases in point:

1) In the late 1940s my mother had a mastectomy, and I was with her when the proprietor of a natural-supplements store told her, "Oh, honey, I could have saved your breast by putting you on lots and lots of carrot juice!" My mother, my grandmother and I (a teenager) all rolled our eyes and openly scoffed at the idea after leaving the store, but there was a hidden grain of truth, as studies in recent years have been linking beta-carotene (the substance that makes carrots orange in color) to cancer prevention. (My mom's still alive at age 86, by the way, thanks to established medical procedures.)

2) Vitamin E was one of these folk remedies for years. Again, recent research is proving it beneficial in maintaining circulatory health, among other things.

3) About two years ago I was in almost-constant back pain, and standing around saying goodbye was excruciating (not to mention standing in lines at movies or the airport). Then two different friends told me about their improvement in back problems through taking glucosamine-chondroitin, something given horses for many years. I began taking it. After six weeks I thought I noticed a difference. After eight weeks I definitely felt better. The issue more-or-less slipped from my consciousness, then after about nine months I realized I had no more back pain. In the meantime a lot has been written glucosamine-chondroitin, and one no longer needs to hear of it only by word-of-mouth. And a couple of months of Swedish research showed dramatic results in a double-blind study (something like 85-percent improvement over the control group, if I remember correctly), taking it beyond "anecdotal evidence" such as mine.

If the herbal industry hadn't been exempted from FDA jurisdiction in 1994, the choice to waste one's wealth on "mostly useless" supplements would have been taken out of citizens' hands; these items would be illegal and a minor battle in the "Drug War." Is that what Daheny would recommend?

--Lois Smith

To the Editor,

"Flower Power" was very interesting and for the most part accurate. As an interested, albeit perhaps ostensibly biased, Western health professional, I would like to offer a few additions.

The single biggest criticism made by those who side with allopathic medicine is that those systems, treatments and remedies collectively crowded under the umbrella of "alternative" or "complementary" lack objective, methodologically sound (by Western standards) research to document efficacy.

First, there is, in fact, a growing volume of well done, comparative studies that put alternative and especially herbal products to the allopathic standard. There are several contemporary publications that objectively evaluate the benefits of complementary and alternative methods. They are as scholarly written and well referenced as any standard and accepted (Western, allopathic) medical source (bibliography available on request).

Second, there are some examples of alternative treatments that truly defy the Western standard of proof. One example is the practice of traditional Chinese medicine. Practitioners of TCM often use multiple components of diagnosis and treatment in the management of a patient's ailment. Those studies that purport to have "tested" acupuncture or the efficacy of a given Chinese herb, in isolation, without the holistic approach of the full range of traditional Chinese medicine practices that would ordinarily be applied for the complaint, have conducted an unfair test.

At the same time, the points about the relative lack of standardization and safety of the alternative products is well taken. The current FDA requirements for bringing a new drug to market include proof of both: safety and efficacy for the claims made. Safety evaluation is also an ongoing, post-marketing requirement. At this time, the Dietary Supplement Health and Education Act (DSHEA) of 1994 requires neither. Standardization of herbal or other "alternative" ingredients, whether for potency or purity, is not mandated. Demonstration of safety falls to the FDA, but only in the context of investigation of claims of harm possibly induced by herbal products--that is, after the fact.

Germany may be the only country in the world where herbal products are standardized. Belief that the German Commission E standards are upheld by those who market herbal products in other countries, when such standards are not required, is probably naïve.

However, to take an honest look at the other side of the coin, one can see what may be considered a double standard. "Evidenced based" medicine notwithstanding, virtually every single day of my professional life, I hear a physician express conviction as to the efficacy of a given medication based on their observation that "the patient is better." The patient is diagnosed with an infection and antibiotic A is started. But after 24 hours, the patient still has a fever, so the treatment is changed to antibiotic B. After another 24 hours the patient is better! Conclusion: Antibiotic B is better than antibiotic A! Noted physician and medical educator Dr. Marvin Turck is credited with the insightful observation that "The plural of anecdote is anecdotes, not data." Perhaps more Western, allopathically trained physicians should heed their own criticism of complementary and alternative medicine.

Dr. Knope was quoted as being in agreement with Dr. Weil on the subject that the mind has an integral part "in how the body feels." Perhaps he offers the olive branch of compromise. Another person quoted in the article, pharmacist and herbal practitioner Concepcion Flores-Ibarra, may have made the most cogent observation when she identified "faith" as the ingredient most often missing from among those things embraced by many mainstream practitioners. A patient's faith in what seems to work should be no more denigrated or less valid than the faith many physicians have in their own anecdotal experiences.

--Dave Apgar, Pharm.D.