"Indications: (partial list) Asthma, Cancer, Chickenpox, Cholera, Depression, Diarrhea, Flu, Headache, Herpes, Nervousness, Paralysis, Ringworm, Sciatica, Toothache, Ulcers, Warts."
--from The Handbook of Medical Herbs, second edition; J.A. Duke (CRC Press, 2002), p. 579
Must be pretty good stuff if it's being promoted for us against all those ills, right? Or perhaps you're wondering: "Hmm -- if this one herb can treat all of that (and more) why would anyone ever be sick?" Or, if you re a bit skeptical, "maybe it doesn't really work all that well, but at least it's an herb and can't do any harm, right?"
The herb in question is poison ivy. And there are sixty-nine other conditions it is useful in treating, if you believe what the herbalists tell you. Celery has seventy-eight indications. Echinacea has ninety. Pussy Willow has seventeen, including loneliness and hemorrhoids. Rice has forty-six, including thirst, breast cancer, and tuberculosis.
Perhaps I'm jaded, but I don't really believe that poison ivy will help my insomnia any more than celery will help my asthma. In fact, browsing through the hundreds of herbs in this book, I couldn't find any disease that wasn'ttreatable by an herb. The logical conclusion, apparently, is that no one has to die of anything, given the right combination of herbs.
In all seriousness, though, some plants and herbs are useful. Drug companies have been conducting natural products research for decades. This involves searching the natural world for crude isolates (from plants, marine life, or microorganisms) and painstakingly purifying and testing the derived compounds against a variety of diseases. Many modern drugs have been discovered in this manner, including some for heart disease, pain, infection, and cancer. A San Francisco-based startup called Shaman Pharmaceuticals was founded in 1989 to search rain forests and speak to indigenous people about plants they used, trying to exploit this knowledge to invent new therapies. Nice idea -- but then again, they filed for bankruptcy in 2001.
The main difference between herbal therapies (those that are useful) and modern drugs is that herbs contain complex mixtures of dozens (or even hundreds) of chemicals, with the active substance, if there is one, typically being one minor component. Sometimes there can be several active components. The other components are either irrelevant or perhaps harmful.
And harmful is not that unusual. There are plenty of toxic herbs -- ephedra, mistletoe, and nightshade being a few examples. These contain poisonous chemicals that can damage your liver, kidneys, and central nervous systems. Modern natural-product-derived drugs are usually the single active component, without all the other stuff.
The mistake people make is to assume that there is no harm in using herbs, since they are natural and have been used for years. I've written at length about the lack of correlation between natural and safe. As for the historical argument, I don't buy it. Mercury was once used as a laxative. Now, if some gets spilled in a lab, the Hazmat team shows up in spacesuits. People used to be pretty sure that the sun went around the earth. Cats and dogs were killed en masse in London in the 1600s because people thought they were spreading the plague. All this did was make things worse, since the disease was actually being spread by fleas living on rats, which, in the absence of the cats, proliferated even faster. Slavery used to be considered OK. So was disco. Just because something was done in the past doesn't make it a good idea in the present.
Like them or not, modern drugs go through a tortuous approval process, where safety and efficacy need to be demonstrated, first in animals, then in large numbers of people. The system isn't perfect, but it works most of the time. There is no such requirement for most herbal remedies, so in effect, if you use herbal remedies you are the laboratory animal unwittingly participating in a poorly run toxicity study involving something that may or may not have any benefit.
Given the absence of legal controls, consumer ignorance, and the huge amount of money to be made, you might expect a bit of fraud here. And you would not be disappointed. The worst of it takes the herbal safety myth and extends the idea one step further. Unscrupulous manufacturers attach the "herbal" label even to the names ofknown drugs and then sell them as if they were some improved, natural, and safe alternative to the real drug. This is nothing more than a modern version of selling snake oil.
Not Always an Altermative
The premise that there exist plant-based (and thus safer) versions of known drugs is a fairy tale, one the Brothers Grimm themselves might consider dark and twisted. Let me be clear about this: if you see a bottle labeled "Herbal XYZ," you can bet that it means one of the following: (1) an herbal preparation that allegedly has medicinal properties similar to XYZ (but is not XYZ) or (2) something that has no use but has real XYZ added to it. Here are some examples of each.
St. Johns' Wort has been used for centuries (especially in Europe) for treatment of mood disorders, including depression. In the 1990s, some companies started selling it as "Herbal Prozac." This enabled people to delude themselves into believing they weren't really taking a drug, since it was something natural. But the active ingredients in the herb are chemicals called hypericin and hyperformin. And guess what? They are drugs. As such, they have side effects, including gastrointestinal disturbances, allergic reactions, fatigue, dizziness, confusion, dry mouth, and photosensitivity. The plant extract also contains small amounts of dozens of other chemicals, including some found in gasoline (source: PDR for Herbal Medicines, second edition, p. 719).
This isn't to say that the herb doesn't work. A 1999 German clinical trial compared the herb to Prozac and found similar efficacy, but it took forty times the dose for the herb to achieve the Prozac result. This brings up a few questions herbal users might want to ask. What dose are you taking? Is there a correct dose? How much of the active ingredient is actually in each capsule? What else is in there? Is the herb more or less effective or toxic than the pharmaceutical product? Are there interactions with other drugs? Do you want to take something that has not been approved by the FDA? And, perhaps most important, should you really be treating yourself for a disease as serious as depression?
Similarly, after fenfluramine (the fen in the diet aid fen-phen) was withdrawn in 1997, something called "Herbal Fen-Phen" quickly popped up. Safe and effective substitute? I think not. The stuff was actually a Chinese herb called Ma Huang or ephedra (for the FDA warning see: http://www.fda.gov/bbs/topics/ANSWERS/ANS00832.html). Last April, the FDA banned ephedra-containing diet aids after more than 16,000 adverse events and deaths were reported. It is ironic that the active ingredient in ephedra is ephedrine, a little-used decongestant and appetite suppressant that is actually rather dangerous. It causes a number of undesired effects, including insomnia, restlessness, irritability, headache, nausea, vomiting, rapid heartbeat, and increased blood pressure.
A different use of "herbal substitutes" involves outright fraud. Here, herbs (or any substance, really) that do little or nothing are actually spiked with the genuine drug. A couple of examples: A group from the University of Toronto (Urology Times, June 1, 2004) recently analyzed a number of "herbal" erectile dysfunction treatments with delightfully understated names such as "Stamina Rx" and "Super X." And guess what? Some of these contained the active ingredients from Viagra and Cialis. If you happen to take these with certain medical conditions, or along with nitroglycerin, you could die. Likewise, in the late 1990s, a number of "natural" psoriasis creams (one of which was Dead Sea Extracts) were found to contain the same potent steroid that the users were trying to avoid in the first place. Without the steroid, the creams were useless. Same idea, same scam.
That one can buy serious drugs (completely unregulated) under the guise of herbal treatments or "food supplements" points out the inadequacy of our current supplement laws. There is an obvious disconnect between science, law, and common sense, with American consumers being the ultimate target.