Opinion: The Need for Clinical Trials of Medicinal Herbal Alternatives

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Synthetic versus herbal: let the testing begin

At The World Congress on Complementary Therapies in Medicine in Washington, D.C. last May, former Surgeon General C. Everett Koop offered data which support my pentameric postulates for phytomedicinals (five conditions under which herbal medicines are often preferable):

1. If you cannot afford a U.S. physician and/or a prescription. (According to the Journal of the American Medical Association [JAMA], more than 40 million Americans were uninsured in 1994, projecting to more than 50 million in the year 2000.)
2. If you cannot communicate with your physician. (Koop said that the average HMO physician today spends six minutes with a patient and, when answering the physician’s questions, the patient is interrupted after fourteen seconds by male doctors and after forty seconds by female doctors.)
3. If your physician has misdiagnosed your major ailment. (He or she is wrong 50 percent of the time when diagnosing Lyme disease, according to JAMA; 20 percent of adult coughs represent undiagnosed pertussis.)
4. If more than one thing ails you. (I believe that most of us have several things wrong with us at any given time.)
5. And if you are deficient in any vitamin, mineral, amino acid, essential fatty acid, or other nutrients (and I believe most of us are deficient in one or more).

Otherwise, the physician’s prescribed synthetic silver bullet may really be the best possible medicine for you.

Why herbs?

Herbal alternatives might be better for you even if you can’t satisfy all of the above “ifs”. Why? First, the herbal alternative is often available to you whether or not you can afford or communicate with your physician. Half of the top-twenty selling herbs are growing relatively untended at my farmette, the Herbal Village, in Maryland.

Second, herbal alternatives contain thousands of biologically active chemicals, including some that can help with most correctly diagnosed ailments. (This is not to say that all herbs are safe; some, of course, are harmful.) Most phytochemical compounds exist in natural ratios, which your genes have experienced in evolution. When you take an herb or combination of herbs your body can sequester many phytochemicals it needs through homeostasis and reject, to a degree, overdoses of those it does not need. Evolution has “taught” your genes to direct this coordinated equilibrium; genes orchestrate the equilibrium of which good health is a major manifestation; disease directs disequilibrium.

Off the mark

The physician’s synthetic silver bullet is only aimed at the targeted ailment. The prescription usually contains one synthetic chemical, which your genes may never have experienced in evolution. If, on the other hand, the prescription contains a natural phytochemical, it has been taken out of its natural context and, now discordant with evolutionary ratios, may produce side effects.

JAMA often publishes comparative, head-on trials of silver-bullet drugs. It re­cently carried a report comparing dihydroergotamine and su­ma­trip­tan for acute migraines (Winner et al., 1996). As always, the trial didn’t include the herbal alternative–which conceivably could be better. (I’m convinced that feverfew, Tanacetum parthenium, taken orally, is safer at least for prevention, and prevention is better than cure, even if it is not more effective than the pharmaceuticals compared in the Winner study and has its own side effects .)

Test to know the best

I lament that most U.S. research is focused on procuring expensive, patentable drugs that act at only specific sites in the body, rather than on finding simpler, gentler remedies, whether herbal or synthetic, that act in a balanced fashion at many sites. I think this gentler approach would save many dollars and much pain. Yet I know of few head-on trials comparing herbal medicines and pharmaceuticals that have been conducted in the United States. And since the U.S. Food and Drug Administration rarely accepts data from overseas, we will continue to wallow in our own ­ignorance.

It would be so easy to ­include the less expensive herbal alternative in the head-on trials. Pharmaceutical firms could team up with manufacturers of herbal supplements so that some marketing benefits might accrue, if the herb proved marginally useful or even better than the pharmaceutical. If the pharmaceutical firms don’t wish to participate, then the ­National Institutes of Health should ­follow the pharmaceutical firms’ ­testing protocols but include the herbal ­alternative. This way we might offer more affordable help and hope to the impoverished 20 percent of our ­pop­ulation who cannot afford allopathic medicine.

Individual action

If you are herbally inclined, you might ask your physicians which pharmaceuticals they would recommend for your ailment, then ask whether there is any proof that they are better than the herbal alternative. Or tell your physicians that you and your friends would like to be the guinea pigs in the trial of the millennium, the herbal David versus the pharmaceutical Goliath. Perhaps you would be in the herbal half of double-blind, placebo-controlled trials comparing the herb with the pharmaceutical.

I want the best drugs, be they natural or unnatural, for my family and myself, but until the comparative head-on trials have been performed, neither you nor I, nor your physician, nor your pharmacist will know whether the pharmaceutical is better than the herbal alternative. America and Americans deserve to know. We don’t.

This Opinion is modified from “Pentameric Phytochemical Postulates” by Jim Duke in News from the Herbal Village 1996, 1(2):1-3. Jim Duke is an Herbs for Health Editorial Advisory Board member.

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