Wednesday, April 02, 2008

Herbal Remedies: Bad Medicine

In the last decade, alternative forms of medicine have become all the rage. From stores like GNC pushing an influx of herbal remedies, to the resurgence of 19th century homeopathy, more and more Americans are turning to alternative medicine when faced with illness. There are a number of reasons for this, but most notably it is due to an increasing distrust of the pharmaceutical industry, bred by many high-profile drug recalls, and a similarly increasing distrust of doctors, who many feel are simply pawns of the pharmaceutical companies. These doctors, many feel, will simply prescribe whatever medicine the drug reps have given them, without much regard for whether it is the best option for a given patient. These suspicions are frequently encouraged by television and print advertisements for alternative therapies, and by practitioners of alternative medicine, such as chiropractors, acupuncturists, and massage therapists.

Unfortunately, there is often a good reason why alternative medicine remains separated from mainstream medicine: it is because in most cases, there is no hard evidence or clinical indication that the therapies work. If a certain form of alternative medicine is shown to be clinically effective over a wide range of the population, it ceases to be alternative medicine and becomes mainstream medicine. Therefore, any therapy that has maintained an “alternative medicine” status for a long period of time should immediately be regarded with suspicion of being ineffective and unreliable. Suggesting otherwise would be like saying that a career minor-league baseball player is as good as a hall-of-famer.

The most prominent face of the alternative medicine craze lies in the area of herbal remedies and nutritional supplements. Thanks to a rigorous advertising campaign, most everyone is familiar with drugs like St. John’s Wort, Gingko, and Omega-3 fish oil. In addition, various vitamin and mineral concoctions have become popular as supplements for every walk of life. Go to GNC’s website, and you will see categories like “Sports Nutrition & Protein,” “Diet & Energy,” and “Health, Beauty, & Medicine Cabinet.” They sell supplements with names like “Muscle Milk,” “Fat Incinerating Serum,” and “Amplified Creatine.”

One of the most common and oft-repeated advertising phrases for these sorts of supplements and remedies is that they are “all natural.” The implication of this assertion is that because they are all natural, they are therefore safe. Unfortunately, this is a blatant untruth. Just because a supplement is all natural does not mean that it is safe, nor does it imply that it is effective. Grass is all natural, and while it may not hurt me to eat a blade or two, it certainly is not going to cure my cold. Arsenic is all natural, but you would not want to ingest arsenic for any reason, ever, unless you were planning on committing suicide. In the 19th century, cocaine was a popular drug prescribed for everything from chest colds to depression. Little did they know that it was also highly addictive and extremely damaging to the body’s organs. But it was all natural! The “all natural” label simply tells us nothing about the drug’s safety or effectiveness. In fact, one should be suspicious of any remedy advertising its all natural content, because this implies that there is not much else of benefit to be focused upon.

Another aspect of the dangers of herbal medicines and supplements is the issue of drug interactions. Most people seem to have the idea in mind that herbal remedies – again, because they are “all natural” – do not carry the same risk of drug interaction that prescription drugs carry. This is a misconception. Indeed, herbal remedies and supplements are just as likely to interact with other drugs and foods as prescription drugs are. For instance, someone receiving an organ transplant could increase the likelihood of rejection by taking St. John’s Wort, because of the way St. John’s Wort interacts with the immunosuppressant medicines given to transplant patients. This, of course, is just one of many examples.

Herbal remedies do not go through the same rigorous clinical testing that prescription drugs go through to prove safety and effectiveness. They are not put through double-blind tests, and their advertised benefits are not evaluated by the FDA. In fact, with any given herbal remedy, the vast majority of its “proven” effectiveness is by word of mouth and anecdotal evidence only. Do not be fooled when you hear a commercial telling you that a given supplement is “clinically proven.” In almost every case, these clinical trials were not overseen by a neutral third party – as is required with prescription medicines – and they almost never include placebo tests or double blind tests. They are typically carried out on a small scale and budget, and are organized and arranged in order to get the best possible results. The method of clinical testing simply does not stand up to that endured by prescription drugs.

Safety is a major issue with herbal remedies, and one that is frequently overlooked. As alluded to above, people assume that a given remedy is safe simply because it is labeled as “all natural.” Again, because these drug concoctions do not go through the same rigorous clinical testing that prescription drugs go through, their safety has not been proven. As with the issue of effectiveness, the known safety of a given herbal remedy is generally through word of mouth and anecdotal evidence. Yet there is plenty of word of mouth and anecdotal evidence that some supplements may not be safe. One story that comes to mind involves my own father. At nearly 60, he has never had a food or drug allergy in his life. Recently, he began taking Omega-3 fish oil supplements. After a few days of this, he began to get sick. Once the sickness and vomiting passed, he began taking the supplements again. It was not until he got sick a second time that he began to connect the two. As a result, he stopped taking the supplements completely. However, a few weeks later, after eating a seafood meal, he got sick again. Ever since that time, he has gotten sick each time he has attempted to eat seafood. There is only one obvious conclusion: the Omega-3 fish oil supplements somehow birthed a seafood allergy that he had never had before in nearly 60 years of life. How did this happen? Well, who knows – the supplements have not had the sort of clinical testing that mainstream drugs go through. And that is the entire point. The safety of these supplements has not been tested and cannot be proven.

It seems unlikely that the herbal remedy craze, or the general alternative medicine craze, will cease anytime soon. So it is important for us, as patients and consumers, to be very careful about the herbal remedies we take, and to recognize that if they could be proven to be highly effective, they would be marketed as prescriptions, not as herbal remedies. In the past, herbal remedies were all we had. One of the many benefits of living in the modern era is that we have modern medicine at our fingertips, and do not have to rely on garlic, hyssop extract, gingko, and peppermint oil to cure our diseases anymore. If those things worked effectively, human beings throughout all of human history would not have been keeling over left and right before the age of 50. The reason those of us in the developed world have an average lifespan of 75 or more, is largely due to the development of modern medicine, and the subsequent decline of herbal medicine and home remedies. Why, then, are so many people interested in bringing these ineffective therapies back to the forefront? Herbal remedy proponents argue that the pharmaceutical industry is only interested in your money, but I wonder if the pot is not calling the kettle black.


DoTheResearch said...

While you raise many good points, I don't think omega-3s should be in the bucket of untested and invalid products. If you go to and search for "omega-3" you will see that there have been over 11,000 studies published in peer-reviewed scientific journals on them. Lipitor claim to be among the most researched drugs in the world, but when you search for Lipitor or its scientific name (atorvastatin), you see that there are only around 3,000 studies published on this. In fact, the science behind them is so strong that the FDA has created a health claim related to their role in the prevention of heart disease...they do not do that unless there is a significant body of science supporting this.

Also, I doubt your father's problems are related to allergic reactions. Any scientist knows that allergic reactions are caused by reactions to proteins, but fish oil capsules are highly refined and any protein is removed, leaving only fatty acids. Also, allergies do not generally suddenly appear. I would guess that it is another reason. He should try taking vegetarian DHA and seeing if the problem recurs. This is one of the omega-3s in fish oil, but it is produced sometimes from vegetarian sources. Good luck!

Laura said...

Scott, good article.

A few things come to my mind: I wonder if the distrust in the medical and pharmaceutical industry is not just part of the larger trend of mistrust in general ie: politics, religion, etc.

Regarding the Omega-3 supplements, fish oils tend to have high concentrations of heavy metals. I wonder if your dad was reacting to those, and subsequent exposures through seafood meals added to his already high toxicity, causing his sickness.

Finally, I don't think we should abandon all herbal remedies just because we have "modern" drugs. I do think we're swinging too far in the other direction right now with overuse of alternative therapies, but some are effective, even if their effectiveness is sometimes in the form of the placebo effect. Some do work, and are without the unpleasant side affects of many drugs.

Thanks for the good info.

Avery L. Jenkins said...

I honestly get so tired of reading commentaries such as yours. The actual facts, had you taken the time to look for them, is that there is quite a bit of evidence for both efficacy and safety of the nutritional products used by doctors such as myself.

Unfortunately individuals such as yourself, who may be unable to either find or interpret the research, continue to insist on the fabrication that there is none.

In addition, every single herb I use in my practice has been used, examined and evaluated by doctors for at least 100 years and in some cases for 1,000 years. We are intimately familiar with these herbs, their actions, and their interactions with other substances.

Frankly, I'll take the validity of multigenerational longitudinal population data over a 6-week study paid for, conducted by, and overseen by the drug company that makes the pharmaceutical in question.

Avery L. Jenkins, DC

Scott said...

Thanks for the comments, folks. You've each made some good points, and I appreciate the feedback.

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