Choosing The Alternative
The Rise Of Herbal Medicine
The small group had been following the herd for days. The old man trailed behind, his joints complaining bitterly with every step. The healer noticed this, and peeked into her bag of dried herbs, selecting a few that would help ease the old man's pain. When the group stopped for the night, the healer steeped the herbs in water heated over the campfire. The old man smiled gratefully as the healer presented him with the steaming bowl of herbal tea.
People have been relying on plants to treat their ailments for thousands of years. Although much has changed in medicine since our ancestor's days as hunters and gatherers, modern medicine still relies on the power of plants to heal. Or, more commonly, plant chemicals that are now synthesized in the lab.
In fact, a study by the BBC in 2002 found that one-quarter of prescription drugs sold in the United States, Canada, and Europe contain active ingredients derived from plants. The familiar drugs aspirin, morphine, quinine, and taxol are used to treat pain, malaria, and breast cancer. They were originally isolated from willow bark, opium poppies, cinchona bark, and Pacific yew, respectively.
Drugs like these, whether over-the-counter or prescription, must be extensively tested before reaching the market. Pharmaceutical companies must meet certain standards for efficacy, side effects, and quality. These testing procedures are costly and time-consuming, a price that is often passed along to the consumer.
Echinacea. Ginseng. Ginkgo. Garlic.
Now, more and more people are choosing to cut out the middleman by diagnosing and treating their medical problems themselves with herbal supplements. The face of herbal medicine, once dominated by patchouli-scented hippies and gauzy New Age types, is changing. Soccer moms are treating their children's colds with chicken soup and echinacea; college students fuel all-night study sessions with energy drinks boasting ginkgo and ginseng. Even in the local convenience store, snacks and drinks touting herbal ingredients are slowly encroaching on traditional junk food territory.
Every year the Centers for Disease Control (CDC) conducts a health survey of American households; a variety of other groups may request supplemental surveys as well. In 2002, the National Center for Complementary and Alternative Medicine, which studies everything from yoga to acupuncture, sponsored a supplemental survey to measure herbal and dietary supplement use.
Jae Kennedy, associate professor at Washington State University, Spokane, used this information to provide the first detailed national portrait of herbal medicine, published in Clinical Therapeutics this January. He found that the herbs listed above were, in that order, the most common herbs regularly taken by Americans. Nearly one fifth of Americans, 38.2 million of us, regularly took at least one type of herbal or dietary supplement. This number had doubled in only three short years since the previous survey in 1999 and is likely to be higher now.
Kennedy found that regular herbal and dietary supplement use was higher among women, middle-aged adults, and college graduates. Those of us in the West are fonder of supplements as well. People with multi-racial, Asian, or Native American backgrounds reported higher usage. Using herbs and dietary supplements seems to be part of a concerted effort to improve health: generally, herbal supplement users exercise regularly, no longer smoke cigarettes, and report being in good or excellent health.
Kennedy's findings show that most people use herbal medicine to complement conventional medicine, not to replace it. For some conditions "like depression and chronic pain, herbs might be a less toxic, less extreme kind of solution," says Kennedy. "These kinds of conditions are tough to treat effectively with conventional drug treatment."
The evidence suggests that many people are satisfied with alternative treatments of chronic conditions. A study from Harvard researchers published in 2001 in the Annals of Internal Medicine showed that almost half of the people who had tried some type of complementary or alternative medicine were still using it 11 to 20 years later.
Hemlock. Nightshade. Oleander. Ephedrine.
However, there are a number of concerns about the use of herbal medicine. "Of all the complementary and alternative medicines, herbal medicine has, I think, the most potential but also the most risk to patients," says Kennedy. "There's this impression that herbs are safe and natural. But they can interact with other drugs and other herbal products and cause serious health consequences." Unfortunately, most people and even many physicians are not aware of the potential dangers.
For example, St. John's wort can decrease the effectiveness of birth control pills. Feverfew, garlic, ginkgo, ginseng, and ginger all thin the blood; using any of these herbs in combination with prescription blood-thinners can lead to uncontrolled bleeding. Ginseng alters blood glucose levels and should never be used by people with diabetes.
The perceived safety of herbal supplements leads many people to use them without supervision. Only five percent of those taking herbs were doing so under the care of an alternative medicine provider. Additionally, two-thirds of people using herbal supplements did not tell their physician.
Herbal medicine use may also reveal fundamental problems with access to healthcare. Kennedy is currently involved in research that shows that St. John's wort use is higher in people without insurance or a primary care physician. "They are self-treating with cheap, unregulated alternatives because they can't afford to pay for prescription medications and psychiatry visits," says Kennedy.
The U.S. Food and Drug Administration classifies herbal supplements as a food, not a drug. They are, therefore, not subject to the same testing, manufacturing, and labeling standards as prescription and traditional over-the-counter drugs. "There is no enforcement using current regulation," says Kennedy. "When you've got for-profit companies selling these products and treating them as benign dietary supplements instead of drugs, that's potentially a problem."
Companies may mislabel, misidentify, or adulterate the products they sell. A study published in May in the Journal of Agricultural and Food Chemistry underscored the extent of this problem. Researchers from Columbia University and the City University of New York tested 11 commercially available brands of black cohosh, used to treat symptoms of menopause. Three of those products contained no black cohosh at all.
Even when products are properly labeled, important information is often missing. "They are not sold with any warnings. The dosage is indeterminate," says Kennedy. "There are no clinical studies for the most part on appropriate dosing. There's certainly no placebo testing of herbal medicines, which is the gold standard for testing pharmaceutical products."
However, obtaining funding for this research can be difficult. "Since you can just go out and pick this stuff, the pharmaceutical industry isn't going to be interested in bringing things to market and identifying the active agents and synthesizing them. So there's no business funding for the kind of clinical trials we get for a lot of prescription drugs," says Kennedy. Governmental funding is available but limited. "The National Center for Complementary and Alternative Medicine is a tiny component of the National Institutes of Health and they are trying to do a lot with a little budget," says Kennedy.
Kennedy has suggested that future research should investigate the role of pharmacists in patient education about potential risks and benefits of herbal medicines. But until more research is conducted and stronger regulations are put in place, the advice "buyer beware" rules herbal medicine.
However, Kennedy envisions a future where patient care is a cooperative effort. "We're trying in this field to encourage at least informing your physician, but ideally moving towards an integrative medicine model where the physician, and the patient, and any complementary and alternative medical providers are working as a team."
Jen Schripsema earned a B.A. in biology from Colorado College. She is currently pursuing a Master's degree in technical communication at the University of Washington.
Photo at Top: St. Johns wort. Photo: Jen Schripsema