Flower Power

Whether or not they work, herbal supplements are hotter than acid at Woodstock.

This is a modern parable of sorts, a cautionary tale of people fearful of science and technology run amok, fed up with the cold and distant monolith that is Big Medicine, and increasingly consumed with the specter of their own looming mortality. But mostly it's a testament to that old saw on which much of American business is based. After exhaustive research, it has been proven that, without a doubt, there is a sucker born every minute.

And that sucker is probably taking herbal supplements.

Once upon a time there were three sisters--Erica, Abby and Alicia. (By a vote of 2-1, they asked that their last names not be used.) The three were born and raised in a small town in Arizona. One by one, they graduated from high school and moved on to the University of Arizona, where each received a bachelor's degree and then eventually all three earned master's degrees in education. Erica and Abby went into teaching, while Alicia went into private business.

All three married their respective college sweethearts and had kids. Abby and Alicia are still married after more than 20 years, but Erica's marriage ended in divorce after a few years. Other than that difference, the three are amazingly similar. They are hard working and vivacious, productive and involved, intelligent and educated (which, as we all know, aren't the same thing).

They all vote, they volunteer their time for charitable causes and they're passionate parents. They exercise on a daily basis and are talented athletes. But where they diverge is that Erica and Alicia take herbal supplements almost religiously, while Abby wouldn't take one if Mel Gibson offered to pass it to her tongue-to-tongue.

And if you asked each of them the reason for their strong feeling in this area, the answer would be the same from all three: I've heard and read a lot about it.

Therein lies the paradox. The business of herbal supplements and the entire field of the wildly misnamed "alternative medicine" is exploding in popularity and profit at a time when there is more information available to the average consumer than ever before in history. What should be a fad met with (ahem) healthy doses of skepticism is instead becoming a cultural phenomenon, one that fuels a perpetual cha-ching machine for the hucksters, manufacturers and distributors of products with at-best shaky claims and records of efficacy.

Business Week estimates that the herbal supplement industry is already a multi-billion-dollar enterprise and is enjoying a double-digit-percentage annual growth with no end in sight. Proponents laud it as a back-to-nature movement as well as a screw-you to the easy-target medical establishment, while critics blast it as high-tech snake oil sales.

Whatever the case, observers in the business world drool over the profits, marvel at the flavor-of-the-month expansion of the field, and are absolutely pea-green with envy over the fact that the industry's growth is being fueled almost exclusively through word of mouth. Think about it: When's the last time you turned on the TV and heard, "This program is being brought to you by St. John's Wort?"

It reminds one of the billionaire who, when asked why he invests in tobacco, said, "What's not to like? It costs a penny to make, you can sell it for a dollar, and people are addicted to it."

Proponents tout it as a true grassroots movement, one unaffected by Madison Avenue. Meanwhile, critics tend to agree with talk-show host Jon Stewart, who says that the only good thing about the Internet is that it allows bad information to go around the world at the speed of light.

Erica is the more devoted of the two herbalies. She estimates that she takes 15 to 20 pills a day, including vitamins, mineral supplements and a wide range of herbal supplements. She takes echinacea, ginseng, St. John's Wort, ginkgo, garlic and gotu kola. According to the literature she has, this last one "aids in the elimination of excess body fluids, decreases depression, increases sex drive, shrinks tissue, helps with liver function ... (and is) useful for fatigue, connective tissue disorders, kidney stones, poor appetite and sleep disorders."

All in one pill! You want to say, "Isn't science grand?" But then you realize that this has little or nothing to do with science.

When asked why she takes the herbal supplements, Erica replies, "They're natural and they're good for you. I've done the research. I sincerely believe that nature provides us with just about everything we need to live a long and healthy life. You just have to know where to look for it."

Why then does she think that doctors respond to such claims with anything from skepticism to all-out derision?

"What do you expect them to say?" she replies. "They're doctors. If people can stay healthy naturally, it'll put doctors out of business. I mean, I'll still go to a doctor if I break my arm, but if I can heal my little aches and pains and (slow down the aging process) naturally, all the better."

Both Erica and Alicia estimate that they spend around $100 a month for their supplements, but they feel that it's money well spent. For a while Erica was also consuming shark cartilage for her early signs of arthritis, but stopped after she had trouble with the cost of around $3 per daily dosage, as well as the overpowering taste of the product. I mentioned to her than in my research, I had come across a less concentrated and therefore less repugnant form sold under the name BeneFin. (You have to admit that's clever.) But she said she has switched over to a concentrated form of wintergreen for her joint pain with the only side effect being that she occasionally smells like Life Savers.

For her part, Abby just shakes her head. "They're my sisters and I love them, but in this matter, they're just nuts," she sighs. "We used to argue about the supplements, but now we just agree to disagree. What I don't understand is that how we can all read the exact same literature and come away with a diametrically opposite understanding of the subject matter."

Abby takes a multivitamin daily just in case her busy schedule keeps her from eating right, and has taken an iron supplement in the past to treat a minor case of anemia. What about other supplements? "I know I'm a teacher," she smiles, "and therefore I'm awash in money, but I think I could probably find a better use for $100 a month. Like maybe Confederate war bonds.

"What bothers me the most," she concludes, "is that these things are being gobbled up by intelligent people who really should know better. It's like we have smart people and really smart people. The smart people think that nature gives us everything, while the really smart people realize that it's just the latest version of 'there's no such thing as a free lunch.'"

JUSTINA PARKER HAS SEEN this phenomenon up close. She worked at an outlet of a national health-food store chain for more than a year before quitting recently to go back to school.

"We definitely had an upscale clientele," she recalls. "You could stand at the counter and look out into the parking lot and watch the Lexuses and Mercedeses pull up. And when they came into the store, they hardly ever asked any questions other than where to find a certain product. They appeared to know exactly what they were looking for and what it was intended to do.

"We used to joke that the Clampetts pick wild dandelions and eat them, while (our customers) prefer to pay $50 for a pill of dandelion extract."

Parker says that she never felt compelled to mislead anybody. If she ever was asked, she would start her response with, "It's supposed to do this ..." or "People say it does that ... ." She says that the packaging is all pretty clear as to the claims, plus, she adds, "there's always that disclaimer."

The disclaimer in question can be found on just about every herbal supplement on the market and almost always comes sneaking in after an asterisk. The bottle will give the name of the herb and then make the claims, like "Grows hair! Fights bad breath! Increases blood flow!" And then comes the inevitable asterisk, which leads to: "These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease."

This disclaimer is the product of a deal the herbal and dietary supplement lobby reached with Congress in 1994, exempting the industry's products from FDA scrutiny. (Homeopathic remedies have been exempt since 1938.) In exchange for the disclaimer, the manufacturers were given carte blanche to operate in the marketplace.

According to an article in the September 17, 1998 issue of the New England Journal of Medicine, "These products have flooded the market, subject only to the scruples of their manufacturers. They may contain the substances listed on the label in the amounts claimed, but they need not, and there is no one to prevent their sale if they don't. In analyses of ginseng products, for example, the amount of the active ingredient in each pill varied by as much as a factor of 10 among brands that were labeled as containing the same amount. Some brands contained none at all."

This latter point was driven home in the now-famous 60 Minutes ambush of local celebrity and self-proclaimed alternative-medicine wizard Andrew Weil.

Weil, who, among other things, claims to have cured his lifelong allergy to cats by taking a "good trip" on LSD and to have "exited his body" during a routine tonsillectomy, used the national forum to espouse everything from healing touch to macrobiotics. But when the subject turned to herbal supplements, reporter Ed Bradley was lying in wait.

It turns out that the ubiquitous Weil openly recommends three brands of herbal supplements, including one company for which he is an unpaid consultant. But when 60 Minutes tested the products of those three brands, they found that they only contained anywhere from 45 to 90 percent of the amount of the product listed on the label. Not one met or exceeded the listed amount. Weil said he would look into it.

When pressed, Weil said, "There are a lot of things in the (herbal-supplement store) that cost too much and probably do nothing."

Undaunted by his own damning confession, Weil then went on to liken the medical establishment to dinosaurs at the time of the Great Asteroid Collision. "They know something has happened, but they're not sure what," he offers with a huge smile through his trademark six-inch beard. But when the author of several best-selling books is pressed to come up with some research to back up his claims, he offers meekly that he is not a researcher, but rather merely a purveyor of information, be it right or wrong.

DR. STEVEN KNOPE IS A FORCE of nature: heart surgeon, black belt in karate, author, exercise fanatic and, he somewhat reluctantly admits, someone "who could kick Andy Weil's ass." Not that he would.

"I like Andy," Knope smiles, "but, boy, is he wrong about things."

Knope is careful to differentiate between those who dabble in herbal supplements as a lifestyle enhancer (better erections, fewer wrinkles--wait, that might be redundant--bluer skies) and those who turn to alternatives as a last-ditch effort in battling diseases that have proven resistant to scientific medicine.

"I will not question someone who is fighting for his life. My quibble is with the person who is looking for the shortcut, who is buying into the nonsense when they should know better. And they know they should know better."

Knope, who works out of the Tucson Heart Hospital at River Road and Stone Avenue, says he wouldn't mind that much if the herbs were all just useless. The problem is that some do serious harm. Some herbs prevent the body's proper absorption of minerals and vitamins. Others interact with foods and other substances to form toxic compounds. But the biggest problem is that people either aren't getting what the product claims or they are getting some unwanted substance along with the advertised herb.

One notable case unfolded in Europe a few years back when a group of people took a Chinese herb that was supposed to aid in weight loss. More than 100 people who took the herb suffered severe renal (kidney) failure and had to be put on dialysis. Several of those patients then developed a rare form of cancer in their urinary tracts, and it was all traced back to another herb that had mistakenly been packaged with the Chinese herb.

Certainly this is an extreme case, but, according to Knope, it is not all that rare. "People have no idea what they're buying," says Knope. "Fortunately, most of it is simply useless and therefore harmless."

He does take the industry to task for allowing so many misconceptions to spread. "Obviously, a lot of the information is spread word-of-mouth and over the 'Net, but the companies should make an effort to tone down the claims. What they're basically saying is, 'Ignore regular medicine. We have something here that's better, more effective and safer, plus we don't have to do anything to prove any of those statements.' And the worst thing of all is that people who would never think of confusing astronomy with astrology or combining Darwinism with religious creationism seem perfectly willing to view untested folklore on an equal footing with science and medicine."

Knope's is not a voice crying in the wilderness. The members of the mainstream medical and scientific communities are almost unanimous in their disdain for this pop culture craze. The Journal of the American Medical Association writes, "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking."

Arnold Relman, former editor of The New England Journal of Medicine (and coincidentally a former teacher of Andrew Weil's at Harvard), writes, "There are not two kinds of medicine, one conventional and one unconventional, nor two kinds of thinking. In the best kind of medical practice, all proposed treatments must be tested objectively."

And University of Nevada at Las Vegas physics professor John Farley adds: "It's not a good idea to integrate nonsense with valid scientific knowledge." Ouch.

Why, then, are these things so popular? Medical doctor Steven Barrett attempts to explain the phenomenon in his informative Web page, Quackwatch.com. Barrett, who often writes with a gee-whiz incredulity at just how stupid people can be, offers: "The 'alternative movement' is part of a general societal trend toward rejection of science as a method for determining truths. [It] embraces a postmodernist doctrine that science is not necessarily more valid than pseudoscience. 'Alternative' promoters often gain public sympathy by portraying themselves as a beleaguered minority fighting a self-serving, monolithic Establishment."

Knope concurs. "There is a general contempt for science. A person can graduate from college these days with just a bare minimum of understanding of math and/or science. Science education has been declining for decades. And in our society it's almost a plus to joke about how much one hates math or science."

But he thinks that there's something more to the exploding popularity of herbal supplements. "There is probably an element of backlash against medicine involved here. Medicine is seen as cold and impersonal, plus it's outrageously expensive. Herbs are looked upon in a romantic sense; it's almost terribly attractive. It's like they came straight from Grandma's kitchen, made with love."

Knope says he often takes otherwise-intelligent friends to task for wasting their money on supplements, but acknowledges that even the most brilliant can go astray sometimes. He points to the case of Linus Pauling.

Pauling, who won Nobel Prizes in both the chemistry and peace categories, is a genius who discovered the nature of chemical bonds and later got over 11,000 scientists to sign a U.N. petition against nuclear testing. But he is probably best known for his claim that megadoses of Vitamin C help fight the common cold. Despite numerous studies, there is absolutely no scientific evidence to back up that claim.

DENNIS BROCKWAY, WHO OWNS and runs the Nature's Sunshine store on East Grant Road, offers his customers a full array of herbs, vitamins, minerals and purified water. Having been in the business for more than 20 years and feeling that he knows as much about the field as any official herbalist, he scoffs at the notion that herbs have no value, therapeutic or otherwise.

"Nature provides us with a lot of good things. We just have to be willing to trust nature and to do what's best for our bodies and minds," he says.

When told of Dr. Knope's assertions that herbs are either useless or dangerous, Brockway bristles, "Well, he just doesn't know what he's talking about. He should go back to school. You know that most doctors go to medical school for eight years and they get about one hour's worth of instruction in nutrition. If you want to know the real facts about herbs, a (medical doctor) is the last person you'd want to ask."

Brockway, who boasts Andrew Weil as a customer, says that he knows of many people who have had their lives dramatically enhanced through the use of herbs. He says that two of his friends were facing heart bypass surgery and through the use of something called MegaChel saw sufficient blockage clearance in the veins to allow them to avoid surgery. He said that the supplement uses the process of chelation (which, until now, I had always thought to be defined as the forming of a heterocyclic ring through the bonding of a metal ion by coordinate bonds to two nonmetal ions in the same molecule).

When asked why he doesn't think there is clinical scientific evidence supporting the use of herbs, he says, "There is evidence! It might not appear in medical journals because it runs counter to their mission. Doctors don't want you to know about herbs because they want to be the ones that heal you. There is a great deal of documented evidence of (sick and well) people being helped by herbs."

Quackwatch warns of a widespread placebo effect in anecdotal evidence surrounding herbal therapy: "When someone feels better after having used a product or procedure, it is natural to credit whatever was done. This is unwise, however, because most ailments resolve by themselves and those that persist can have variable symptoms. Even serious conditions can have sufficient day-to-day variation to enable useless methods to gain large followings."

Practicing what he preaches, Brockway takes several herbs daily, including goldenseal, to provide "an unfriendly environment for bacteria"; cat's claw, for the immune system; and cascara sagrada (sacred peel), which he says is an herbal laxative and "helps to keep the intestines and colon clean."

According to the American Medical Association, the belief that fecal material gathers on the lining of the intestines is a pernicious myth, completely without scientific basis.

No matter, says Brockway. "I and lots of other people know that these things (herbs) work. I also know that doctors are going to keep on trying to prove that they don't."

CONCEPCION FLORES-IBARRA OPERATES the Yerberia San Martin de Porres in Agua Prieta, Sonora, only a few blocks from the Mexican border at Douglas. The American-educated woman has worked in pharmacies in Phoenix and Flagstaff, but a family illness and what she refers to as "a deeper calling" prompted her to move back to her birthplace. She is currently operating out of her mother's spacious home on the east side of town, not far from Cerro Gallardo, where Pancho Villa amassed his troops before laying siege to Agua Prieta 85 years ago, but she's planning to move her business closer to downtown to make it more convenient for her U.S. customers.

Flores-Ibarra has a unique perspective having worked as an herbalist and in a pharmacy. "I understand the doctors' objections. But I think the two main reasons they don't have any clinical evidence on herbs is that they refuse to do them and if somebody else does a study, they won't sanction it."

Her knowledge of herbs has been passed down, mother to daughter, for generations. "My family was working with herbs back when 'medical doctors' were using leeches. They've made great strides, but we were already at our peak. I know these things (herbs) work for certain things, but I don't make outrageous claims.

"My mother always jokes about what happens when the gringos get ahold of things. I think that the health-food store kinds of herbs are to herbalism what Taco Bell is to real Mexican food."

To what, then, does she attribute the medical establishment's hostility toward herbalism? "Where do I begin?" she laughs. "That's just too easy. Let me just say that what I do involves faith, faith in nature, faith in the healing powers of the body and faith overall. There's no way a study will ever be able to measure faith."

AN EXASPERATED KNOPE realizes that he and his fellow scientists and doctors are fighting an uphill battle here. "It's really ridiculous," he says. "You want to have better sex? Exercise, get in better shape. There is nothing more dramatic in improving the quality of life than to exercise regularly. You want better blood circulation? Exercise. You want to feel better, look better, work better? Exercise, eat right, get enough rest. There's no magic formula and there is no magic herb."

In his book The Mind-Body Connection, Knope does share one pathway with Weil. "I agree that the mind plays a big part in how the body feels. A positive outlook on life can help a person not get sick so often and get well sooner when they do get sick. But I don't believe that there's an herb or some other supplement out there that can click something on in your head and give you a better outlook on life."

Does Knope take any supplements? "No. I take a multi-vitamin."

And his advice for those who do? "Try to be careful. The good news is that most supplements are absolutely useless. The chances are that what you're taking isn't toxic, so you can get away with it. All you're doing is wasting your money."

Which probably isn't such a smart thing to do.

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