Qi Spot

Remember how I wrote about biased headlines? (http://qi-spot.com/2010/02/09/another-biased-headline/)  In that previous article, I had mentioned that one can subtly affect comprehension by careful(?) selection of words to use in a headline.  The headline in question then read “Researcher Warns on Herbal Medicines”.  Only when you read the article itself will you see that it actually warns against misuse of herbal medicines or potential side effects from mixing with western meds.  The typical reaction, however, is to just glance over the headline – giving one the impression that herbal medicines PER SE are something generally unsafe and thus there is a need to warn the public about it.

Compare that with this headline: “Mixing medicine with herbal remedies can be risky.” (http://news.medill.northwestern.edu/chicago/news.aspx?id=158237)  This is much better and not misleading at all.

A few quotes from the article proves the spirit of the writer’s intent.  Allow me to refresh you:

Dr. Arshad Jahangir, a cardiologist at the Mayo Clinic in Phoenix/Scottsdale Arizona, who wrote the review, said the main reason patients look to herbal remedies is because they want to preserve their health.

“They think it’s natural and probably safe to use,” he said. “We’re not saying anywhere in the review that people should not take these products. But they should, at the very least, consult with their doctors who can look at their other medications and identify the potential for harm.”Herbal medications readily found over-the-counter can adversely affect the way prescription drugs are absorbed by the body by either enhancing or reducing their effectiveness.” (emphasis mine)

Yes! The article fits the headline!  And for the record, I perfectly agree. Next we see that integration between “eastern” and “western” medicine is promoted.  (albeit in a method I don’t agree with 100%, but I’ll take what is given.)

Christina Ferrari-Noonan, an acupuncturist and herbalist at Ancient Healing Chicago downtown, said patients who want to take herbal remedies should consult their doctors first.

“Patients should definitely go by the physician’s recommendation and see what they’re comfortable with,” she said. “There are definitely a lot of over-the-counter herbs that can be considered dangerous.”

Ferrari-Noonan, who has a background in Eastern and Western medicine, said herbalists should work in conjunction with doctors “We’re diagnosticians in traditional medicine not in western medicine,” she said. “Patients need to go their doctor first to get diagnosed. That diagnosis needs to be in place, and then as herbalists, we can go from there. Blood tests are especially valuable as a starting point.”

What I don’t agree with is the last sentence.  At times, people present with discomforts that cannot be classified in western medicine (how do you translate “Spleen Qi deficiency leading to weakness of the four limbs” into western medicine?  It isn’t CFS, it isn’t a movement disorder, etc etc) or do not appear in blood tests.

Jahangir agreed that herbalists and physicians should work together. “We’re not at war with herbalists and they are not against what we do,” he said. “Our goals are common, which is to serve our patients and to give them medicine or products that will do the job it’s supposed to do without causing harm.”

Tell that to the skeptics who insist that only commercial pharmaceuticals are worthwhile.

Mary Helen Lee, an herbalist at Chicago’s White Moon Healing Center, said herbal supplements could be beneficial as a compliment to chemical-based drugs, if taken correctly. “It’s definitely possible to take herbs to reverse the toxic side effects and lessen the harm the chemicals medications can have on your body,” she said. (I do this a lot with cancer patients on chemotherapy – Phil)

Lee said incorrect dosage amounts could also cause problems. “Either people are taking too much or too little, which can have a major effect,” she said. “Obviously, there are some dangerous herbs out there and people should be cautious. Patients should see a professional and get the correct herb and the correct dose for their problem.”

Experts agree that the biggest mistake people make is to self-diagnose on the Internet and treat themselves with over-the-counter herbal remedies without consulting doctors first. (emphasis mine)

“The Internet can be very helpful in educating yourself about herbs and possible effects, but it can also be very dangerous,” Ferrari-Noonan said.

So there you have it – a more balanced view that can be summarized thus:

a) herbs can work if used properly

b) always tell any healthcare professional about everything you’re doing for your health.  If they become biased against you because of that, then it’s time to find another provider.

c) never self medicate – there ARE herbal scammers out there who are only out to sell you stuff.

d) physicians of all traditions CAN and SHOULD work together.

“Researcher Warns on Herbal Medicines”

(http://www.abc.net.au/news/stories/2010/02/08/2813236.htm)

Looking at the above headline, what thoughts enter your head?  Obviously it is an attempt to ingrain into the public mind that herbal medicines are dangerous per se.  Sadly, that’s not what the article says.

A forensic pathologist thinks some people’s embarrassment about taking herbal medicines can leave them vulnerable to taking a lethal cocktail of drugs.

Professor Roger Byard of Adelaide University has published a research paper on the dangers of herbal medicines when taken in large quantities, injected or combined with use of prescription drugs.

He has found it can lead to serious illnesses, worsen pre-existing conditions or cause death.

Professor Byard says people are often reluctant to tell their doctor they are taking herbal medicines for fear of ridicule, but it can be a fatal mistake.

“Although obviously a number of herbal substances are quite safe, you don’t know what’s in the package sometimes and there may be interactions, so it is important to talk to your doctor,” he said.

He says his research was sparked by the death of a young man who had injected a Chinese medicine chan su, which contains a toxin from toads.

“The materials that can be added include heavy metals, there’ve been cases of mercury poisoning and arsenic poisoning, lead poisoning, also sometimes the manufacturers will add western pharmaceutical agents, so they’ll add drugs that we manufacture to the herbal medicines to actually increase their effect,” he said.

Much has been made about the non-effect of Ginkgo Biloba on alzheimer’s disease.  Surprisingly for the critics I ‘d have to agree with them.  Gingko Biloba works in Chinese medical theory by increasing blood flow.

In the classical text of “Ben Cao Pin Hui Jing Yao” it states that the characteristics of the leaves of yin xing are bitter sweet, astringent, neutral. and belong to the lung meridian and can control the lungs and calm asthma, calm the mind and arrest pain, rid of water retention and stop diarrhea…

…The main usage of the ginkgo leave extract is in cardiovascular therapy (including dementia caused by circulation dysfunction.)

(http://alternativehealing.org/ginkgo.htm)

So in theory, it should work only in a limited subset of patients with dementia.  It won’t work for most dementia patients, actually.  Personally I find that memory in general is better improved by tonifying Blood through the Kidney or Spleen.

But how did this come to my attention?  This work of art:

Gingko (sic) Biloba and other ‘Natural’ Remedies May Be Dangerous

by Benjamin Radford

http://news.discovery.com/human/gingko-biloba-and-other-natural-remedies-may-be-dangerous.html

I can’t help but smirk at this one.  At the risk of some commenters saying that it’s obvious when something gets under my skin, I have to say that these headline crafters are geniuses.  Radford takes the studies that show Ginkgo biloba isn’t as effective as it is thought to be (which I myself believe, never having prescribed it for dementia and memory problems and instead focusing on diet) and uses it as a springboard.  He mentioned ephedra, which I will comment on later.

In the meantime, what’s my irk?  Firstly, I have to honestly say the headline is true.  Well, I’ll have to be more specific.  Ginkgo Biloba and other natural medicines not only MAY be dangerous, they are DEFINITELY dangerous if not used properly!  I mean, come on, if one believes that a substance is powerful enough to effect changes in physiology so as to create a tangible medical effect, surely it is pure idiocy to believe that it can be taken at uncontrolled doses by just anyone without any adverse reactions!  We do not expect such sheepishness when we take western medicines, why shouldn’t we take the same attitude towards natural herbs?

This is also the fault of unscrupulous marketers who only care about selling their product.  To my commentors, I have to say that yes, news bias irritates me, but one thing that irritates me more is hearing “alternative” healers go about with such bullcrap as “oh it’s natural, there’s no such thing as an overdose, it’s safe.”  Oh please, I’ve seen people get admitted to ICUs for renal failure due to herb overdose.  The worst thing about such real quackery is that it gets real practitioners who only want the best for their patients lumped into the same duck fraternity as the herb pushers.

So why is this headline ticking me off? It’s the intention.  It’s obviously designed to plant suspicion in the minds of readers: God/Mother Nature is a quack.  Natural products “may be” dangerous.  Weasel wording.  You could say the same thing in a different way: “Natural Medicines Must Be Used with Caution” would say the same thing but with obviously different intent.

But on to the article:

According to new study in the Journal of Natural Products “restrictions should be placed on the use of Ginkgo biloba because of growing scientific evidence that Ginkgo may increase the risk of seizures in people with epilepsy and could reduce the effectiveness of anti-seizure drugs.”

Agreed.

Herbal supplements and remedies are not marketed as drugs (note the paragraph of legal fine print on bottles starting with, “This product is not intended to diagnose, treat, cure, or prevent any disease.”) That’s because in many cases the drugs have not been scientifically tested for safety or efficacy. They have not been proven to work in carefully-controlled clinical trials.

Here in the Philippines, they are marketed as “food supplements.”  This is bad, not because the herbs haven’t been tested (some have been, some haven’t, with varying degrees of success/failure), but because such dichotomy will lead the public into polarization.  Either they will join the “all natural, all safe” bandwagon or the “all unscientific” bandwagon.  Neither wagons are worth getting hitched to.

But here comes the kicker:

The herbal supplement industry is a multi-billion dollar business, and has lobbied hard to keep their products from being regulated by the FDA. As a result, the FDA can only step in when something goes wrong, after people have been injured or killed by natural herbs.

That’s just what happened in 2004, when the FDA banned ephedra, an herbal remedy used in traditional Chinese medicine for thousands of years. Millions of consumers took the herb, on the belief that it was natural, safe, and effective. The herb was widely used for treating everything from the common cold to asthma to weight loss. Then the herb was linked to over 100 deaths; healthy people who took ephedra had a wide range of symptoms ranging from insomnia to heart attacks.

Now it seems another natural herbal remedy may pose a hidden danger. All drugs, whether pharmaceutical or “natural,” can have dangerous and unintended side effects. But when people are harmed or killed by an herbal supplement that has never been shown to work in the first place, the situation is all the more tragic.

While it is true that herbal supplements are a big cash cow, I’m not a big fan of the FDA, seeing as they’ve had a tendency to rush approval of drugs (remember bextra?) and are seemingly dominated by Big Pharma.   The story of Ephedra is appropriate for this.

I refer you to this article for more clarity: Safety Issues Affecting Chinese Herbs: The Case of Ma Huang <http://www.itmonline.org/arts/mahuang.htm>

Herba Ephedrae or Ma Huang is usually the first herb one would see in a typical textbook of Chinese herbal medicine.  It is usually used to clear early symptoms of flu, and not ALL kinds of flu.  ANY look at the texts will give SPECIFIC indications for it’s use.  However, western herb enthusiasts had, according to the article, “converted from an herbal treatment for diseases to an energy stimulant and a weight-loss product.”

What are it’s classic textbook uses?

Actions: induces diaphoresis, resolves surface, ventilates the lungs to relieve asthma, regulates water metabolism.

Applications: febrile diseases due to exterior-excess, fever, chillphobia [aversion to cold], anhidrosis [lack of perspiration], ostealgia [bone pain], arthralgia, cough with dyspnea, edema, edema due to wind.

From this, it becomes obvious that Herba ephedrae is meant to be used in actual illness, not in a healthy person just trying to get a kick or lose weight.  The weight loss aspect is gleaned from it’s strong diaphoretic effect.  However, a basic look at any  Chinese herbal textbook will show that administration of ma huang should stop WHEN PERSPIRATION BEGINS, whether or not the flu has dispersed.

Again, if the patient has external symptoms (chills, slight fever, arthralgia, muscle pain) with no sweating, ma huang may be given AS PART OF A FORMULA to mediate effects (see ma huang tang, among others) and should be STOPPED when sweating begins.

Also, it should not be used as a tonic.  Many of the early ma huang/ephedra “supplements” were mixtures of ephedra and other tonics (including caffeine!)  Disaster waiting to happen.

How does that compare with western enthusiasts taking the herb individually for what we MDs would term as “off label use” contrary to all warnings?

OF COURSE they’ll get sick.  A professor of mine in China warned against yin collapse (shock due to blood or fluid loss) after using too much sweat-inducing herbs.

So what’s the take home message?

1) ANY herbal medicine should be prescribed by a trained and qualified health professional.  That may depend on your country or state.  In the United States, there are licensed acupuncturists.  In Japan, only MDs can prescribed Chinese formulas.

2) Always research any herbs you may want to take.  Find out all about them.  If it’s a chinese formula, learn about why the herbs are combined together, at least in theory.

3) NEVER EVER believe the “all natural so all safe” argument.

4) We should regulate Chinese herbs to ensure quality (prevent fakes, etc) but at the same time, have them regulated by Chinese herbalists, not MDs or quack herbal “experts” like the ones who gave Ma Huang and Ginkgo a bad name.  Real Chinese herbalists would never mix Ma Huang with caffeine, knowing exactly how it works.