Is It Good Medicine?

By Christine Gorman

If you've ever nursed a cold with hot tea and honey, jump-started the day with a cappuccino, or soothed a sore throat with a mentholated cough drop, you've practiced herbal medicine. These remedies are so much a part of our daily routine that no one thinks them flaky. Nor do most doctors mind that you use them--as long as you don't overdo it. So why are so many U.S. physicians reluctant to recommend herbal supplements? Is it just a matter of ignorance and provincialism?

No. Physicians have legitimate concerns about the safety, efficacy and potential misuse of the herbal products that their patients are snapping up. More and more M.D.s, like their patients, accept that some herbal products may help where conventional treatments fail. The difference is that doctors tend to be more demanding of proof. Or as Dr. Yank Coble of the American Medical Association puts it, "In God we trust. All others must have data."

Fortunately, those data are starting to trickle in. At the urging of its members, the A.M.A. for the first time devoted all its research publications last week, including the flagship Journal of the A.M.A., to scientific studies on alternative, or complementary, medicine. As with conventional medicine, the results showed that some treatments work while others don't.

One of the more intriguing studies, conducted in Australia, found merit in Chinese herbal treatments for irritable-bowel syndrome, a gastrointestinal disorder that strikes 10% to 20% of the population in many industrialized countries and for which conventional medicine often offers only symptomatic relief. The study also showed the lengths to which researchers must go to make sure that the benefits ascribed to herbal remedies are not due to a biased analysis of data, or to patients' expectations--the so-called placebo effect.

Doctors in Sydney recruited 116 patients who had not responded well to Western treatments. They divided them into three groups and sent each group to a Chinese herbalist, who wrote each patient an individualized prescription based on his or her complaints. Each prescription was then filled at a different location, where patients were randomly given pills that contained either a placebo of flavored compounds that tasted like herbs but had no medicinal effects, a standardized extract of 20 herbs designed to support bowel function in general, or the individually prescribed herbs. After 16 weeks of treatment, the two groups that received herbal medicines had fewer symptoms and less pain than the placebo group. But 14 weeks later, only the group that received tailor-made herbal remedies still felt better.

Most of the other studies that were reported last week yielded mixed results. Researchers at St. Luke's Roosevelt in New York City determined that Garcinia cambogia does not, by itself, help patients lose weight. A review of all the studies conducted on saw palmetto found significant improvement in urine flow in men with enlarged prostates. But the reviewers cautioned that the saw palmetto studies lasted, on average, only nine weeks, too few to determine long-term results.

Because herbal remedies are not regulated in the U.S., consumers should read the best available studies before trying them. With a few notable exceptions, much of the information about herbs on the Internet is unreliable. But authoritative books are available from the American Botanical Council and the Medical Economics Company. (See "Hitting the Books on Herbal Cures," p. 65.) Here are a few other tips:

--Don't assume that "natural" means safe, unless you want to risk ending up like Socrates, who committed suicide by drinking hemlock. More recently, folks have suffered liver damage from sipping teas brewed from comfrey, an herb that is used in poultices and ointments to treat sprains and bruises and should never be taken internally. Special note to pregnant women and nursing mothers: you should avoid a number of herbs, including Echinacea, senna, comfrey and licorice.

--Make sure what you're taking is pure. Last May the FDA verified industry reports that certain shipments of ginseng were contaminated with high levels of a fungicide. Elaine Kang-Yum, a pharmacist at the Hudson Valley Poison Control Center in Tarrytown, N.Y., who tracks herbal medicines, says some imported Chinese remedies have been doped with Valium or other prescription drugs.

--Look for standardized preparations so you know you're getting the same product with each new bottle you buy. As any baby boomer who ever smoked more than a single joint knows, potency of herbs can vary from batch to batch. German manufacturers, though, produce identical batches of herbal remedies, as required by their law. This week the U.S. Pharmacopeia, a nonprofit organization, published the first American standards for the potency of nine herbs, including chamomile, feverfew, St. John's wort and saw palmetto. Manufacturers that adhere to those standards can add the letters NF, for national formulary, to their labels.

--Buy from companies that research their products. For example, most studies of ginkgo biloba, which appears to delay the progression of early Alzheimer's disease in some patients, have been conducted on an extract produced by Schwabe of Germany and distributed in the U.S. by Nature's Way (Ginkgold) and Warner-Lambert (the Quanterra line). The best-studied version of St. John's wort, which seems to work for mild to moderate depression, is Kira, produced by Lichtwer.

--Be sure to tell your doctor what you're taking. According to last week's J.A.M.A., 15 million Americans take herbs at the same time as prescription medications. Yet 60% of patients don't tell their doctors that they are taking herbal remedies, which would at least allow the physicians to watch for potentially serious drug-herb interactions.

--Don't let herbal preparations lull you into ignoring serious problems. "A lot of my patients with hepatitis C take milk thistle," says Dr. Melissa Palmer, a liver specialist in Plainview, N.Y. "It seems to normalize their liver-function tests, but it doesn't affect the underlying disease."

Finally, don't expect a pill to make up for an unhealthy life-style. No herb can take the place of exercise. Some of the most healthful plants you can consume are leafy green vegetables like broccoli and spinach.