Sunday, 5 May 2013

Mostly Plants: The Medical Edition

As I've mentioned in previous posts, I spend a lot of time reading Tim Ferriss's books. The 4-Hour Workweek was a particular favorite, but I also enjoyed the 4-Hour Body overall, in particular because he gave a chapter to Ben Goldacre, one of the best voices calling for honesty in science and medical reporting that we have these days. I used to love reading Goldacre's Bad Science column, and I still have a lot of time for the guy - not only is he right in calling pharmaceutical companies out on dishonesty in drug trials (full disclosure: I own stock in Pfizer, Novo Nordisk, Gilead and Actavis), but he writes extremely well.

But sometimes I suspect that Goldacre, as well as Ferriss, is a little confused about the difference between homeopathic medicines and herbal medicines. As I say, it's been a while since I've read Goldacre regularly, so I could be wrong about him in particular, but I find this confusion is pretty widespread - I once had to explain the difference between homeopathics and herbals to my editor on the pharmaceutical magazine where I used to work.

I think it's mostly cultural, to be honest - certainly in the UK or the US, if you asked people about herbal medicines, most would probably mention traditional Chinese medicine and/or quackery. I once asked a dermatologist about whether a certain condition could be improved by changing my diet, and she responded by lecturing me about Western medicine. A certain type of person seems to be associated with herbal medicine, in short (hippies, to be blunt).

What annoys me about this is that some of those who are anti-herbal medicine (whether or not they think herbals and homeopathics are the same), are effectively trading one form of dogma for another.

A quick disclaimer before I go on: I don't believe in homeopathics, or at least, I won't until they're proven to be effective in properly designed clinical trials. At the same time, I don't believe that herbal medicines are automatically better or safer because they're "natural"; I'm not the first to observe that shark bites are also all-natural, but they aren't going to do you much good. On a less flippant note, herbal medicines like St John's wort are associated with stomach upset and shouldn't be taken with certain other drugs.

But the reason this pro-"science" orthodoxy bothers me is that it ignores the origins of Western medicine. The example I like to use is that perennial favorite of fantasy authors, willow bark. White willow bark contains salicin, which is similar to the active ingredient of aspirin (acetylsalicilic acid) and is associated with similar pain-relieving effects (note my very scientific hedging there). Another fascinating example is a kind of centipede (or possibly spider) found in Australia, whose name escapes me now but was at the Poisonous Animals Museum in Kuranda, Queensland; according to the folks at the museum, Aboriginal tribes used this animal's bites to treat arthritis.

As I've since joked with Australian friends, it's hard to be too worried about spiders here in the UK when even the scary-looking bugs back there might do you good if they bite you.

In any case, the other point I like to make when it comes to the value or otherwise of herbal medicines is that the European Union actually has a regulatory framework for studying and approving herbal and traditional medicines; these medicines make up a significant part of the OTC markets in countries like Germany, so it makes sense that regulators would want to be sure they actually work (something the US FDA could take note of, frankly).

To sum up, herbals ≠ homeopathics; herbal medicines have roughly the same mechanism of action/delivery method as normal drugs, ie you ingest some of it. It's good to be skeptical of things that come with the all-natural tag, but remember that the point of skepticism is to learn more about something that gives you pause, not to blindly write it off as bullshit.