Herbal Medicines: Some Things to Consider

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As there is growing interest in herbal medicines, treatments, and therapies, I thought I would lend my thoughts to the subject.  I will likely anger people on both sides of the argument.  It has been my experience that when there are two strongly opposed sides, the truth lies somewhere in between.

First:

Yes, I think there is a place for herbal medicine in modern healthcare.

Yes, I am an M.D.

Yes, I think some herbal treatments work.

Yes, I instruct some of my patients to use certain herbal medicines.

No, I do not think all herbal medicines work.

No, I am not corrupted or blinded or brainwashed by the evil pharmaceutical companies.

Second

I am not going to get into specific herbs right now.  I’ll save those for later posts  

Now let me get started… 

Statement: Modern physicians don’t like herbal medicine.

My Answer: That is, by and large, true.  

But why is that?  To be honest, there is some indoctrination to it.  As we go through our medical education, there are the random comments by some pious educators talking negatively or flat out mocking herbal medicine or those who use it.  It is unfortunate, but true.  Also, we see many people get really sick or who die because they were relying on herbal medicines for treatment of their medical conditions.  The vast majority of the time, these people are either very anti-establishment types (and wear a tinfoil hat to keep the government from reading their minds) or, sorry to say, are not the sharpest tool in the shed.   Finally, there is very little good research about herbal medicines (see my next section).  These reasons generally cause a lot of physicians to at the minimum remain very skeptical about herbal medicine.

Statement: Doctors say there is not any research to support herbal medicine use.  This is because the evil pharmaceutical companies are suppressing the truth. 

My Answer: The truth is there is very little good research on herbal medicine.  

Here’s why: Drug companies want to make money.  I know that the researchers who work for these companies truly want to help humanity.  I know many of them personally.  They are good people using their scientific brains to try and beat diseases the best they can.  The corporate side of things is different.  The management of drug companies want to turn a very healthy profit.  In part, this is a good thing.  The company makes drug A which treats disease 1 really well.  They make a profit.  They do research in disease 2.  They develop drug B which really works.  They make a profit.  They do research…. and on and on.  Overall, this model has saved millions of lives across the globe.  In the U.S., whole herbs are considered food products.  They cannot be patented.  Which means a drug company cannot charge $150 a month for using them.  Which means they have little interest in using the whole herb.  Since the vast majority of research into medicines is done, or at least funded, by drug companies, and they have no interest in a specific herb since there is no return of investment, then little research is done on it.

That is not to say that NO research is being done.  There are grants given out every year to investigate herbal treatments.  The National Institute of Health now has a Complimentary/Alternative Medicine branch to do research in herbal medicine.  It has been very interesting to see their results.  I must add, that the amount of high quality research into herbal medicines is growing quickly each year. 

Statement: There is a lot of research out there.  You don’t like it, because it shows herbal medicine works, and you are against herbal medicine. 

My Answer: There is a lot of research out there.  A lot of it is poorly done.

What makes research good or bad?

First, good research has a lot of people in the study.  What sounds more reliable: a study with 10 people or a study with 1000 people?

Second, good research uses randomization.  This means you separate the people in your study into different groups at random.  There are a lot of reasons why this is, and if you really want to know, I can give you a more detailed answer.  

Third, good research uses a placebo and/or a third medicine.  What sounds more reliable: a study that give 30 people herb X or a study that compares 10 people with herb X, 10 people with modern medicine Y, and 10 people with placebo Z.  (For those that do not know, a placebo is basically a fake medicine, like a "sugar pill")

Fourth, good research uses blinding.  This means the people in the study, and in really good studies the people giving the medicine, do not know if they are in the herbal medicine group, the modern medicine group, or the placebo group.  Single blinding is where the subjects do not know.  Double blinding is where the subject and researchers do not know (until after the study is done).

There is a lot more to it than that, but this is a good basis from which to start.  In reality, most herbal medicine studies rarely fit to any of the above standards.

But you say, “I have this book that says the research shows…”  In almost all cases, herbal medicine books offer very little proof that an herb works.  The book may say, “It has been used for hundreds of years for…”, or “according to this herbal medicine specialist…” or “patient X used it for this disease…”.  Where is the proof?  Who cares if it has been used for hundreds of years by the most well respected Chinese herbalists?  At one time people thought tomatoes were poisonous.  We believed the earth was flat!  Oftentimes, tradition has little in common with truth.  That is not to say these herbs do not work, it is just that tradition alone is not proof.

But you say, “This herb has been shown to kill cancer.”  LOTS of chemicals (including herbals) have been shown to kill cancer cells – in a petri dish!  There is a HUGE jump to say it will work in a human body the same way it worked in a petri dish.  If that is all the “research” you have, I would be very careful about using it, and I would never recommend it to others. 

Statement: “My mother had cancer and took this herb and now she is cancer free!” 

My Answer: I say that is wonderful!  But how do you know it was the herb that did it?  

In medicine, we are still learning how the immune system works and how the body repairs itself.  Would your mother have beat the cancer on her own anyway?  Was it that she stopped eating fast food and exercising more?  Was it the chemo?  Was it people praying for her?  

Whenever we have a story about herb X doing something for one person.  We call it anecdotal.  Practicing anecdotal medicine is very dangerous.  People die when we treat a disease a way that has not been studied well.  When we hear a bunch of stories about herb X healing people, that gets our attention.  If it is believable and preliminary studies (good research) shows there may be something to it, drug companies often jump into the game and try to isolate the chemical in the herb that is working.  That is how we got salicylic acid from willow bark (we now know it as aspirin). 

Statement: Herbs are safe because they are natural. 

My Answer: This is one of the most dangerous myths about herbal medicine.

Water is natural.  

Water in the right place, in the right amount, without contaminants, is safe.

Water in the lungs kills people every year – drowning.

Drinking too much water kills people every year – water toxicity.

Drinking too little water kills people every year – dehydration.

Drinking water with contaminants kills people every year – poisoning.

And this is just water, not a plant with so many more complicated chemicals.

Let’s look at this another way.

If a person is taking an herb, they expect it to do something to their body.  If it does something to their body, then it is what we call bioactive.  ANYTHING that is bioactive as a potential to interfere with a body's normal function.  That is the whole point!  We want the herb (or other medicine) to DO something to our bodies.  We hope that it is a good thing, something that will help us.  Bioactive compounds can have side effects.  They can interact with other medicines.  People can have allergic reactions to them.  People can die from the wrong dose, the wrong application, from a contaminant, from mistaking one herb for another… the list goes on.  

Just because a herbal medicine is from a plant does NOT mean it is safe. 

Statement: This herb will always work for this condition. 

My Answer: If someone tells you this, they are usually lying (either on purpose to sell you something, or because they are misinformed).

Plants are very dynamic life forms.  There is so much involved into why a plant produces certain chemicals or not.  The French have a term for it: terroir.  They used it to describe all the geographical components of the land their grapevines grow to produce great, good, or bad wine.  You can grow one plant with rich soil with certain percentages of minerals, with a certain sun/shade ratio, with a certain humidity level, with a certain amount of rain fall, with a certain temperature range, with a certain insect pest, with a certain sun angle, etc.  You can grow the same plant in a completely different terroir, and the chemicals in the plant will be very different.  One plant may help with headaches, and the other makes them worse.  One plant may boost your immune system, while the other does nothing, or gives you an allergic reaction.  One plant may calm you if you drink it as a tea, the other may give you insomnia.  This is why the drug companies try to isolate the bioactive compounds that give certain results (and then they can patent that chemical and make money of course.)

Certain bioactive compounds in plants are very reliable, and some are very unreliable.  It takes good research, great record keeping, and usually quite a bit of time and experience to know which plants will produce which bioactive compounds under which conditions.

Statement: I’ll go to the store and pick up a bottle of herb X. 

My Answer: Don’t count of Herb X being in a bottle marked Herb X.

What?!  That is right.  Since there is no government organization (NOT THAT WE NEED ANOTHER ONE!!!!!!)  to monitor herbal medicine content (remember, they are sold as food, not medicine), there is no guarantee that what is on the label is actually in the bottle.  A very large, very well done study examined this issue.  The researchers went and bought a bunch of bottles of herbal medicines from different companies and from different stores across the U.S.  The results were that about 70% of the bottles contained some form of the plant.  It may have been the root or leaves or flowers, but most samples did not specify which part.  This is important if you are looking for a root or a flower specifically, and that bottle only contains leaves.  The study also showed that 30% did not even contain the herb that was printed on the bottle!  The bottom line is that there is poor quality control in the herbal medicine business.

Statement:  You sound very negative about herbal medicines, but you say you tell you patients to use them. 

My answer: Be skeptical.

In an ideal world, we would know exactly how and where to grow our herbal medicine.  We would know what dose to use and how to take it.  We would be able to go to the store and buy the herbs we cannot grow ourselves and trust what was on the label.  Right now we can do none of those things with 100% certainty.  

So now what?  

Investigate the evidence for using an herb you are considering.  Try to find the research and read it yourself.  A lot may be technical, but you can get the general idea if it is good research or not.

Get a good book on herbs side effects and interactions (The Physician’s Desk Reference for Herbal Medicines is a great one).

Grow your own herbs if you can so you know what you are actually getting.  My advice is to grow your herbs in different micro-climates on your land and see which ones are better at treating the condition they are traditionally known for.

If you have to buy your herbs, do your research into the company that makes it.  What are their quality controls?  

Let your physician know what herbs you are using, so they can help you best.  If your physician says not to take it, ask them for the reasons.  If they have none (which likely means that physician is just anti-herbs), consider finding a new physician.  If they can give you a reason with evidence to support it, then take their advice.  

Hope this helps.