Herbal treatment, Phytotherapy: sound science or big business?

In the first part, we discussed why evidence-based medicines are expensive .

Part two: Why do phytotherapy practitioners take the easy route?

We observe increasing use of herbal treatments called phytotherapy. Why are these products attractive, and are they effective and safe? Moreover, are phytotherapy practitioners choosing the easy route?

Over the last two centuries, we have witnessed scientific progress and modern medicine markedly increase lifespans, make many formerly incurable diseases treatable and eliminate some entirely. Medicine nevertheless fully recognizes that many health problems still require better solutions.

In recent years, an apparently insatiable market has emerged for everything “natural,” “traditional” and, above all, nonscientific. The result is rejection or devaluation of scientific medicine’s efforts in controlled trials, proof, evidence, statistical significance and safety in favor of “alternative medicine,” putting increasing numbers of patients’ lives at risk.

Complementary and Alternative Medicine (CAM) probably has its most commercially successful and widely used branch in herbal treatments called “phytotherapy.” In most countries, these are tablets, powders, plant extracts and liquid mixtures called elixirs, sold as “dietary supplements” through herbalists and pharmacies.

The herbal product market is growing. Despite interest, only a few products have been shown beneficial for some mild-to-moderate problems, such as ginseng for fatigue, ginger for nausea, and St. John’s wort for depression and seasonal affective disorder. They have consistently failed when tested for more serious conditions. Unable to qualify as “medicines,” they therefore maintain their market under labels such as “natural,” “supplement” or “traditional.”

Wealthy, culturally sophisticated and educated people appear more inclined toward herbal treatments. Women in their 30s and 40s are the largest consumers. This is both surprising and expected.

One reason is modern medicine’s limitations. Despite major treatment advances, science still has many unanswered questions. Scientists and health professionals recognize these limitations and strive to improve every treatment they practice.

Another important factor is continued belief that everything called “natural” is good and safe despite abundant contrary evidence. Biology enthusiasts know nature contains many poisons, tobacco being one example. Some amateur researchers share this misconception, which is also phytotherapy practitioners’ greatest error.

Another overlooked point is that “natural” loses meaning in human physiology. The body cannot physiologically distinguish chemically synthesized vitamin C from citrus-derived vitamin C. How natural is taking concentrated plant-extract tablets at hundreds or a thousand times the concentration found in nature?

How much can we trust herbal product contents when they are not strictly regulated like drugs? Some “ginseng tablets,” for example, contain no ginseng. Supposedly “natural” remedies are sold with little verifiable information about claims, effects and dangers.

Concern about synthetic drugs’ side effects also drives phytotherapy interest. Leading complementary medicine scientist Professor Edzard Ernst said herbal medicines “claim” to be gentler, milder and safer than harsh treatments needed for many life-threatening diseases. It is unsurprising that weaker effects bring fewer side effects, yet we encounter many patients harmed by herbal treatments in daily practice.

Seeking complete recovery in advanced disease (for example stage 4 metastatic cancers) is another motivation. Desire for herbal treatment is stronger among stage 4 patients for whom standard treatments cannot promise cure. They and relatives experience hopelessness and tension while believing alternatives will save them. Phytotherapy practitioners observe this and can promise “complete healing,” despite no evidence for herbal treatments controlling or curing cancer.

A final motivation, as in many CAM branches, appears to be self-medication’s attraction. Wanting the greatest, even sole, control over one’s life is characteristic of our era. Yet it is surprising that people readily entrusting hair, homes or cars to experts overlook such care for their health and bodies.

We neither forget nor ignore that plants remain rich sources of medicines. Aspirin, now wholly synthetic, was derived from willow bark a century ago. Paclitaxel, a frequently used effective chemotherapy, originally came from a yew tree. Researching plants for effective drugs continues. Production, however, involves isolating active chemicals with advanced technology rather than simply extracting plants. The fashion for everything “natural” causes dangers or ineffectiveness of some phytotherapies to be ignored. Without proper research and regulation, this trend remains nostalgia.

Conclusion

Alternative medicine providers face rapid change in our country as in developed countries. Practitioners in this enticing market quickly transform into professionals, doctors and even academic authorities. Their similar, photocopy-like books with striking names seek a share of the magical, rapidly growing market, with titles such as regimen, healing visibly competing to sell immortality. Rich or poor, immortality is something people always want to buy. This universal unrealistic demand feeds scientific fraudsters’ enthusiasm and motivation. Manipulators hide their real intentions among statements that are ninety percent or more correct and publicly acceptable. Targeted messages between the lines confuse society, undermine trust in science and, through covert promises of immortality, increase irrational demand to create a market.

These are not difficult to see if you look carefully. Recognizing fraudsters is easy when a statement, speech or book suggests every illness has a solution and immortality is hidden in nature, while offering a method, herbal regimen or natural product in exchange.