• Studying Herbal Remedies
    Part one of a four part series
  • By Herbert Webb, MD
  • Dr. Herbert Webb is a pulmonologist in private practice in San Pedro, CA, and an illustrious graduate of the program at Harbor-UCLA. He is Medical Director of the San Pedro Hospital Pulmonary Medicine Department and their Pulmonary Rehabilitation program. He wrote this article for their Better Breathers' Club newsletter. With their gracious permission, we share it with you.
  • Let me start by saying that I am definitely not an expert on herbal remedies. My perspective is that of a skeptical, professional, conservative, mainstream pulmonary physician, and my watchwords are "Prove it to me that is safe and effective before I put it into my body or recommend it for you." I approach this task hoping to accommodate an attitude that herbals can be complimentary rather than an alternative to conventional medications.
  • We can't ignore that herbals, megavitamins and nutritional supplements are a major issue of our time. In 1999, United States consumers spent over 14 billion dollars on these items. Over 500 different herbs are marketed, and 200 of them are relatively common. The top ten account for approximately 50% of herb sales. These include echinacea, garlic, ginseng, gingko biloba, golden seal, ma-huang, saw palmetto, and now glucosamine and chondroitin sulfate. Half our population between age 35 and 50 has tried alternative measures of some type. There is now even a PDR (Physicians' Desk Reference) for herbal medicines.
  • So, marketing forces bombard us every day with information, both good and bad, about these agents. The medical profession is trying to respond to a clear-cut need in the public's eye to be more caring, more soothing, and more open to the idea of herbals and supplements. Fifty percent of United States medical schools now have alternative medicine courses, and the FDA is trying to respond to this issue as well. The genie has definitely been let out of the bottle and it won't go back in, so it is prudent to learn quickly for our patients' sakes as well as our own.
  • Why do people have such zeal to take herbals and megavitamins? The idea of an easy to obtain and easy to take pill is appealing. We Americans also have a strong urge for self-control and controlling one's own destiny. Also, the emphasis on prevention is enticing. Many believe "olde is good"----it was good enough for Grandma, so it's good enough for me! And others think that "natural is safe". (But, as we shall see, there isn't any more reason to think that natural is safe than that "synthetic is not safe". More on this later.)
  • Many physicians zealously argue AGAINST all herbals, and many citizens manifest religious fervor FOR herbals, rejecting all prescription medications. These two extremes seem just that to me-extreme. We need less polemic and more science.
  • In defense of doctors, I must remind you that it is extremely difficult to keep current in your own medical specialty nowadays. There are only 24 hours in a day, and the information explosion in our own fields is demanding. Herbal remedies are another branch of healing entirely, one in which few United States physicians have been trained, and even if a doctor is inclined to research, finding reliable scientific evaluation of herbals to study is very difficult. Herbs, of course, do have action on the human body, which means they have side effects and toxicities and drug interactions and even interactions with other herbs. It is important to remember that herbals contain active ingredients, chemicals like the biochemicals synthesized by pharmaceutical companies. You can't just dismiss these preparations as harmless or placebos (as some physicians unwisely do!). Herbs are potentially dangerous, as well as potentially therapeutic. So, I think you should think of herbals and nutritional supplements as drugs, just like FDA-approved pharmaceuticals, with side effects, toxicities and drug interactions.
  • So, if there are certain similarities between herbal remedies, dietary supplements and FDA approved pharmaceuticals, what are the differences? A basic difference between herbal remedies and standard drugs is that the Food and Drug Administration controls only the latter. This includes testing, safety controls, manufacturing, standardization, and a formal system to report adverse reactions once the drug is out there. We have all heard side effect stories and read inserts listing precautions for standard Western-type medications, so everyone is quite aware of side effects, toxicity and interaction issues with traditional therapies. If herbal preparations were in fact controlled by the FDA, my expectation is that we would hear about side effects and herb-to-drug interactions just like we do with FDA-controlled and synthesized medications. We haven't heard much about problems with herbals because there's no way to report adverse reactions, and no regulatory body to report them to.
  • Another problem surrounding the current state of herbal use is a disturbing lack of scientific studies. Unreliable information is more dangerous than no information at all. Reliable scientific studies of herbal preparations are scant, and very few studies meet the scientific scrutiny that is required for all FDA approved medications. So, what do I---and the Food and Drug Administration---consider a solid, worthwhile scientific study?
  • First, a study should answer a specific question, like "Does drug Z decrease strokes in men over 60?" or "does herb X lower diastolic blood pressure in women over 50?" It should be a double blind, randomized, placebo-controlled design. A placebo, of course, is a "sugar pill": that doesn't have any effects. The real deal and the placebos are identical in appearance and are assigned tracking numbers, so they can be given out at random. This way, neither patient nor researcher knows who's getting the placebo, which eliminates emotions and prejudices from coloring the results. Make no mistake; the placebo effect is very real. Expectation that something is going to help you is a very strong factor and can actually provide positive results. In all asthma studies done with placebos as a control, there is a dramatic placebo effect---in other words, people who took fake asthma medication reported breathing better. In a recent study of a baldness remedy, 86% of the men taking the therapeutic agent claimed hair growth, but so did 42% of those taking the placebo!
  • A good study should also have as many participants as possible---the more the better. The people in the study should be able to tell researchers their subjective opinions on whether their pill helped or not. Although subjective feelings are important, the researchers should also be able to measure their study question objectively, which in the case of the blood pressure study, would be easy to do. (You'd think it would also be fairly easy to see if a remedy grew hair, but apparently not.) Last, but certainly not least, the study should be reviewed by experts in the field before it is published.
  • Now, I can read medical scientific journals by the thousands with articles on drugs meeting the above criteria, but there are virtually no such sources specifically directed at herbals and supplementals.
  • The next question is, if there aren't any scientific studies for my doctor to read, then, where can I get decent consumer information? The Harvard Medical School Health Letter is the best, and the Mayo Clinic, National Jewish Hospital and Johns Hopkins also have good information for you. These general health letters do contain information about herbals, vitamins and supplements amongst their many other contents. The Nutrition Action Health Letter is excellent, and concentrates on food, nutrition, supplements and herbs.
  • Harvard Medical School Health Letter
    79 Gardener Street
    Cambridge, MA 02138
    (617) 495-1000
    Mayo Clinic Health Letter
    Subscriptions: PO Box 53889
    Boulder, CO 80322-3889
  • Generally speaking, if someone wants to sell you something, you should be very wary. Commercial advertisements, material you receive in the mail, promotions, sales pitches, and Internet sites of any commercial nature are poor sources of accurate information. You can also categorically reject panaceas which claim to cure your insomnia, improve your memory, promote weight loss or weight gain, increase energy, reverse your baldness, cure your impotence, soothe your arthritis, decrease your shortness of breath and prevent a heart attack as well. It's true that prescription medications are now advertised directly to the public, but you still must obtain them through physicians. The fact that your doctor, who knows your condition, allergies, and other mediations, has to be consulted for a new prescription is a safety feature, not a bother!
  • We hope that you liked this article as much as we did. Part 2 will be in next month's Second Wind.

  • Do you have a question about respiratory disease that has been bothering you? If so, feel free to write and ask us, either through our web site or by mail. We answer all of your letters.