Science Versus The Herbalists
Sun Herald
Sunday May 4, 2003
The Pan Pharmaceuticals disaster has thrust the alternative medicine industry into the spotlight. Frank Walker reports.
AS pharmacists pulled millions of pills labelled ``natural", ``alternative", ``complementary", ``herbal" and ``traditional" off their shelves during the week, Premier Bob Carr put the situation bluntly.
Some may work, he said, but others were ``very, very dubious", and he compared the spruiking of the pills to the medicine-man hucksters of the 19th century.
It was time, he said, for a review of the exploitation by the trade, and called on people to be far more sceptical when it came to the claims of slick advertising behind alternative medicine.
Mr Carr has an uphill battle. Powerful vested interests are at work. It has grown to be a $2.3 billion industry with 60 per cent of women and 42 per cent of men taking some form of alternative medicine.
The Federal Government rakes in $230 million a year in GST from the products. Chemists earn a threefold mark-up and are keen to keep them on shelves. Industry spokesmen warned that 5000 jobs and 500 small businesses were at risk.
Defenders of the industry were quick to point out that Pan's manufacturing methods were the cause of the massive recall, not the products themselves.
But the recall brought the trade into sharp focus, and critics trumpeted the call for more regulation of the industry that has more than its share of shonks and charlatans.
Professor Alastair MacLennan , head of obstetrics and gynaecology at the University of Adelaide, became one of the leading critics after he saw so many of his patients taking alternative medicines which had harmful side effects.
``We find 40 to 50 per cent of pregnant patients are using herbal products, some of which are toxic to the foetus," he said.
``Three in four children coming into the hospital have already been subjected to some unproven form of therapy.
``The truth is, probably 1 per cent of what is on the alternative medicine shelves have been proven to do what they claim to do in proper scientific tests where they are tested against a placebo [dummy tablet].
``Recently there were 19 separate trials of alternative medicines used by pregnant and menopausal women and none had a greater benefit than the placebo.
``They don't work in menopausal symptoms, osteoporosis, heart disease, mood controls or vaginal symptoms."
Professor MacLennan said the industry had run riot since the G overnment relaxed laws covering alternative medicines in 1999.
As long as they were marked as ``nutritional supplements" they did not have to be tested, provided the claims they made were not over the top.
``You could put your grass clippings into a pill and sell it as a help for menopause or cancer and get away with it under the current laws," he said.
``If you produce an active compound from a herb or vegetable and you call it `alternative' you do not have to do any scientific trials on it to make sure it works.
``But if you produce a pharmaceutical agent from the same herb or vegetable and call it a `pharmaceutical medicine' you have to go through millions of dollars worth of trials to check the dose is effective, does not cause undue side effects, say what part of the population it is meant for, and list if pregnant women or children can take them."
``As soon as someone uses the word `natural' you are being conned. It means nothing. You can have natural mercury, natural lead, natural arsenic. It does not mean natural goodness."
Professor MacLennan said supporters of alternative medicine ignored reports of side effects and scientific evidence that they did not work as claimed.
``Echinacea has all sorts of side effects. St John's wort can produce skin disorders and photosensitivity, but they don't tell you that."
Professor MacLennan said there should be proper testing of all medicines, including those calling themselves herbal, alternative, complementary or natural.
``Medicine should not be split between alternative and conventional, but between proven and unproven."
Dr Ramesh Manocha , clinical research fellow at the natural therapies unit of the Royal Hospital for Women, said very few of the herbal and alternative medicines he tests have any effect.
``We took some products off the shelves to test them and found they had virtually no active ingredient in them at all," he said.
But he insists there are some proven benefits from herbal medicines.
``In no way does the current Pan situation call into question the fundamental validity of complementary medicine.
``Complementary medicine is here to stay and will continue to be popular with consumers."
Dr Manocha said many herbal medicines had been scientifically proven to work, but the problem was the lack of control over what was put out on the alternative market.
``Only a very small proportion of complementary medicines have been scientifically validated. But those that have been proven in proper tests are accepted as having a very legitimate and worthy role in maintaining our health.
``There are a lot of cowboys in this industry who pick the buzz words, purchase dirt-cheap extracts of the herbs on the world market and put them in a pill.
``They sell it off and make a motza and by the time people realise it is useless they are on to the next one," Dr Manocha said.
Despite the scientific doubts, the medical establishment has opened the door to complementary medicines. The Australian Medical Association acknowledged last year that most GPs occasionally recommended alternative therapies to patients and that they ``may have a role in mainstream medical practice".
Two universities in NSW, Charles Sturt and Newcastle, offer degrees in natural therapies and complementary medicine. Herbal medicine is taught in Sydney University's pharmacy faculty.
Complementary Healthcare Council of Australia president Dr Ian Brighthope said the action taken against Pan should not tarnish the whole industry.
He said 60 per cent of products did not come from Pan and he assured consumers it was safe to keep taking medicines that had not been withdrawn.
But some people in the industry want to grab this chance to go further and have alternative products stand up to scientific testing.
Nigel Pollard, managing director of Flordis, imports herbal products from Germany and Switzerland where he says they have been scientifically tested and proven.
``The Pan disaster has brought the issue to a head" Mr Pollard said. ``We are facing a credibility crisis and the industry clearly now needs clinical data that proves the products do work.
``The public should be asking if these products really work, and the manufacturers should be made to provide evidence."
Susan Dean, president of the National Herbalists Association of Australia , said there should be registration of alternative practitioners and disclosure of ingredients. ``We are concerned about shonky products and practitioners, and we support any moves for registration of herbalists and naturopaths," she said.
WE ASK THE EXPERTS TO RATE THE TOP-SELLING PRODUCTS
Susan Dean is president of the National Herbalists Association of Australia.
Ramesh Manocha is clinical research fellow at the natural therapies unit at Sydney's Royal Hospital for Women.
What is it for? Brain health and memory.
Herbalist Susan Dean says: Brahmi is used for improving memory, but ginkgo is more complex and should be used cautiously. Ginkgo reduces blood clotting and should not be used with aspirin. But people tell us it works well.
Scientist Ramesh Manocha says: It improves memory concentration and some thinking processes. There is quite a bit of scientific evidence that it does work.
What is it for? Nervous anxiety, tension.
Herbalist says: Kava was withdrawn from use after a woman died from liver problems after using a product which had kava and another unknown herb in it. It is not used properly by many but we use it against anxiety.
Scientist says: Good evidence it is effective for dealing with anxiety.
What is it for? Cancer, arthritis.
Herbalist says: I don't think it has any shark in it at all. Some are even using bovine cartilage. Needs to be taken long term and some studies show it is looking promising.
Scientist says: Shark cartilage is actually a conglomerate of different organic components. Each of those parts has been shown to be potentially useful for arthritis. No evidence it works on cancer.
What is it for? Stress, mild depression.
Herbalist says: It is not a cure-all but is good for mild depression. We use it for the nervous system. It also works for shingles.
Scientist says: This is top of the list. Without doubt it is under utilised by health professionals. It should be the first thing most GPs think about prescribing as an anti-depressant. It is 100 per cent scientifically proven to help against mild to moderate depression.
What is it for? Lower blood sugar levels and helps arthritis.
Herbalist says: There are serious quality control issues and we get low quality ginseng from China here in Australia. It is meant for degenerative problems of old age.
Scientist says: The jury is out on ginseng. There are all sorts of claims for it but no evidence to back them up.
What is it for? Urinary infections.
Herbalist says: It must be used without sugar or it won't work.
Scientist says: If taken continuously, it can help to prevent recurrent urinary tract infections.
What is it for? Boosts the immune system.
Herbalist says: Stimulates the immune system and helps with allergic responses. It needs to be used properly. It won't make any difference if you take it against a cold.
Scientist says: A moderate amount of scientific evidence, but not enough to narrow down what specific species is best or what the dosage form or amount should be. It needs a lot more clarification.
What is it for? Pre-menstrual problems.
Herbalist says: A lovely tonic for women's reproductive organs and helps with painful periods.
Scientist says: There is a very well-designed clinical trial in the British Medical Journal showing it is effective for pre-menstrual syndrome.
Why is it taken? Prostate problems.
Herbalist says: Helps men's reproductive system and it is safe.
Scientist says: There are a number of scientific trials indicating extract of berries from this plant are effective for treating prostate enlargement.
What is it for? Menopause symptoms.
Herbalist says: A traditional native American herbal medicine that was used for muscle pains. It is fantastic and marvellously effective.
Scientist says: A number of trials show it is effective for hot flushes and other symptoms of menopause.`
What is it for? Inflammatory skin disorders.
Herbalist says: It has anti-inflammatory effect and an anti-bacterial action. It is very relaxing and calming and we use it for children's conditions as it is safe.
Scientist says: There are two trials suggesting certain extracts of chamomile are effective for mild skin inflammation. It is not the first thing I would pick.
What is it for? Sexual performance.
Herbalist says: Herbal practitioners don't use it. Some patients tried it and reported no life-changing improvement. This is a marketing gimmick.
Scientist says: There is no evidence whatsoever that it works. It is a great marketing name and that is all it has going for it.
What is it for? Cardiovascular problems, cholesterol, colds and flu.
Herbalist says: It works against infections and lowers blood cholesterol. You have to be careful about the dose and what else the person is taking.
Scientist says: The active ingredient in garlic is allicin . There are clinical trials showing it is effective in treating the common cold. Trials show it is mildly effective for controlling elevated blood cholesterol. There are better things to use.
What is it for? Weight loss.
Herbalist says: No sign that it works. Doesn't make the grade.
Scientist says: No evidence it works. Eating a balanced diet and exercise is the only natural therapy that loses weight.
© 2003 Sun Herald
