Herbal Medicine Debate

I was intrigued by a reader’s comments on herbal medicine and have replied to her comments below, in italics.  Which position do you take?

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Ssurvy states:

Relying overmuch on what science says about herbs is ridiculous. Science doesn’t study herbs, it studies constituents of herbs in isolation, and at huge doses. Herbs work differently than that – the various medicinal aspects work together on the specific person/situation.

Science has studied herbs both in and out of context, in various doses, trying to understand and quantify the mechanism of action.  The case of foxglove and the related drug digitalis is probably the best-known example.  How does foxglove help the heart?  It couldn’t be every chemical or protein the plant contains.  Identifying the active compound helps understand not only how the plant works, but how the heart works.  On a biochemical basis, this knowledge is not acquired from herbal medicine alone.  This is not to discount thousands of years of experience, but many ineffective treatments have been used for years as well, some of which do harm people.  Saying that the various components of herbs work synergistically is probably true, but with so many variables, it becomes difficult to solve the “equation.”  Using several medicines in conjunction creates much the same problem, and polypharmacy is a significant problem, especially for older patients.  Scientists need to learn from knowledgeable herbalists, but the opposite is also true.

Example – antimalarial drugs – usually have huge bad side effects for some, one specific drug (and I can’t name names, for obvious reasons) with harsh side effects is entirely derived from one plant, but isolates some chemicals in the plant, adds fillers. But if you take the plant as an antimalarial, it has none of the side-effects. Why? Because the other plant chemicals, and their total interaction, either prevent or avoid those side effects.

Living in America, I have not had the opportunity to treat malaria, so what the reader says regarding herbal therapy may be  somewhat true.  However, most patients do not experience harsh side-effects from medical treatment, and it is unlikely that no one experiences deleterious effects from plant therapy.  (If this plant is so effective in malaria-prone regions, why is it that malaria is such a problem?) 

Looking to science is great, but traditional use, across cultures, may lead to more accurate information. Scientists don’t know WHY or HOW yarrow stops bleeding, and some scientists say it does, others say it doesn’t. But it does (thousands of years of human-yarrow experience, and personal experience are the proof I need, not whether science can agree), regardless of what science might think that day.

A big problem with scientific research is the cost of randomized, double-blind placebo-controlled studies.  Smaller, case-control or similar studies could be done in the field of herbal medicine, but getting them published in respected journals remains a problem.  If I had the financial freedom (and hence, time) to perform such research, I would.

Not that science is bad. It isn’t, but it is also not the whole story. Herbs don’t work the way drugs work.

I would argue this point.  On a biochemical level, the active compounds must work similarly, on the same receptors, proteins, binding sites, enzymes, etc.

Many herbs are only useful in, for example, some types of high blood pressure, with a specific cause, but won’t do a thing for the other types/causes – which makes great sense, but to science, that just means it doesn’t work. if you have a greatly overweight middle-aged man under lots of work stress who eats lots of carbs and fats and sits all day, a pregnant woman at week 29 with swollen legs, high bp, and can’t eat or drink, and a older thin woman with no previous history of high bp who is also experiencing dizziness and confusion, you have three very different situations.  Why one would expect that their remedy would be identical is a mystery to me.

Excellent point, but the same is true of medications.  Physicians do not use the same approach to elevated blood pressure in every situation either.  The underlying cause is essential to the understanding and treatment of most conditions.

 Yes, science says many herbs, if not most, are useless, but that is a flaw of science, not herbs. Herbalism has been practiced throughout human history. It’s not the new kid on the block, our so called modern medicine is.

Another excellent point, but science attempts to bring greater understanding to the table.  Taking the example a few paragraphs back, it’s great to say that yarrow slows bleeding.  Applying a few leaves to a minor wound is unlikely to cause much harm, and may help a little.  Does this suggest it might slow heavy menstrual bleeding?  Or benefit those with hemophilia?  Would too much thicken the blood and cause blood clots?  Like other active compounds, does it produce other actions within the body?  Are there any drug interactions?  Where do you turn for information?  Effects observed in nature are often the starting point, but we need to understand the chemistry as fully as possible.

I applaud this writer for the depth of understanding he or she has expressed.  Many good points have been raised.  Much research remains undone, especially for treatment of serious disease.  My thanks to the contributor of these comments. – Doc Cindy

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
This entry was posted in Herbal and complementary, Herbal medicine, High blood pressure, Medical archives, See medications - herbal. Bookmark the permalink.

7 Responses to Herbal Medicine Debate

  1. Mike M, APRN says:

    I am as far from a practicing herbalist as one could be, but on the other hand, I have recommended fish oil for cholesterol problems and irritable bowel (it works). Apple juice, apple cider, and prunes help constipation. Mint soothes a sore throat and honey helps a cough. I could go on, but I think you get my point. Remember I am not an herbalist, but I make a point of taking note of things that work whether there is “scientific research” that supports it or not.

    • (And I mention many of these in my book, Armageddon Medicine, especially those that have definite scientific support. – Doc Cindy)

    • Charles, MA, LCDC-III, CPC says:

      You bring up a good point — many herbs are food! Even staunch supporters of “science based medicine” practice herbalism by the food they eat. Much of herbalism is not treatment focused — it is preventative. Even doctors advise patients to eat a variety of fruits, vegetables and whole grains.

      When “science” gets too involved with food, we get HFCS, GMO crops, weird preservatives, artificial flavors/colors and other Frankenstein foods that aren’t so good for us. That’s not to discount science, but like everything else, it has limitations.

  2. Rev. Laura says:

    One comment to GoneWiththeWind – witchdoctors, eh? Perhaps I am one of them, but I will tell you this, just like in modern, scientific medicine, an herbal remedy must be carefully selected. Not all herbs are created equal, the amount must be correct and herbs are definately NOT meant to slice and dice the human body like some machine, and many times they don’t get rid of the symptom (like we have come to believe is the medicine is working!) but ‘cure’ the disease. Sometimes it takes TIME and the body has its own wisdom in these things…a fever is there for a reason, not just to make you hot and miserable. Do I believe in bringing it down? Yes, in certain cases…the problem most people have, in my professional opinion, with herbals is that YOU don’t want to be uncomfortable, take responsibility for yourself, and make changes in your behavior, nor have to remember to do something more than once a day. After all, it’s easy to take a pill and make it all go away for the moment.

    I do get the fact that sensationalist marketers have made herbs seem more than what they are (no different than big pharm drugs) but there IS a place for herbs in modern times and there is a place for big pharm drugs…it is not an either/or situation…but it’s the wisdom in knowing the when, and then taking responsibility for yourself instead of handing it over to someone else.

  3. Harriet says:

    Perhaps a medical drug is effective for a particular problem, perhaps when you read the actual research you find that while it might be statistically significant, it may not clinically significant. That is while the drug company trumpets as being 50% better than something else for a particular condition when you look at the absolute difference they only make a 1% difference to the patient. That is you have to treat 100 to make a difference to one person. This is common. But it is not commonly known to patients, nor often to the doctors who don’t read the actual research but take the assurances of the drug company representatives.

    Most patients believe a medically prescribed drug has at least a 90% effectiveness in treating the condition, but as a researcher on sabbatical, I discovered that it is often less than 5% and some of the regularly prescribed drugs have less than a 1% effectiveness, or even none.

    So if you are going to be sarcastic Gonewiththewind then at least look in depth at the medical literature. I discovered that the results were so horrendous I can no longer work as a health researcher. My colleagues have sold out to the pharmaceutical companies drive for profits because they need a regular weekly income, too. But it has nothing to do with science, nor care for patients.

  4. GoneWithTheWind says:

    Perhaps a herb is effective for a particular type of high blood pressure. Perhaps it’s not! Maybe it is just “claimed” to be effective. Many herbs were claimed to be effective for one illness or condition but when tested turned out to be useless. If you have high blood pressure why depend on witch doctor-based medicine to treat it? Even if an herb were effective for your illness is it effective all year or only in the Spring or Fall? The content of plants vary during their growth and after they die. So how much do you take? Two leaves, three flowers, one root??? What if it isn’t enough? What if it is too much? What if it contains other chemicals or compounds that are poisonous? Most of the so-called herbalist base their “knowledge” on superstition and old wives’ tales. Most of the lure about herbs cannot stand up against fact based investigation. There have been some herbs/plants that offerred medicinal effects but for the most part these plants were incorporated into science-based medicine long ago. What is left that has any real value? I intend to stick with science-based medicine. You are free to continue buying questionable herbs from questionable sources. My best advice to you is take two willow twigs and call me in the morning…

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