Botanical remedies, herbal supplements, alternative treatments. Science has long frowned upon some of the medicinal potions and practices of the Eastern world and those from bygone eras in the West. But many of the disdained "old wives' tales" have been showing up in over-the-counter preparations produced by legitimate pharmaceutical companies. The effects of medicinal herbs and Chinese techniques are even being recognized by some medical doctors in crisp white shirts who until recently would have expressed their skepticism by peering over the tops of their glasses.
A Cedars-Sinai Medical Center internist who has also studied herbal and other "alternative" approaches to health care, says the Internet and other sources of information and health products are giving patients greater control of their own care, but a great deal of caution should be exercised.
While many Western physicians may still believe that over-the-counter herbal supplements are a harmless but poor substitute for advanced technologies and prescription drugs, some are recognizing that renewed interest in ancient remedies may be impacting the health of their patients -- sometimes in a positive way, sometimes not.
"Some doctors have thought that herbal supplements were so ineffective that they wouldn't hurt you. They assumed that these substances would not help but thought there was no cause for concern if a patient wanted to take them. Now we're seeing that in fact these substances do have activities within the body. Something that could have a positive effect could potentially have a down side, too," says Mary Hardy, M.D., medical director of the Integrative Medicine Medical Group at Cedars-Sinai Medical Center. The program integrates Western medical practice with botanical medicine, traditional Chinese approaches, acupuncture and other "alternative" therapies.
In addition to being a board-certified specialist in internal medicine, Dr. Hardy is a member of the American Botanical Society and the American Holistic Medical Association. She encourages her patients to assume greater responsibility for their health but says they often need guidance to help them evaluate product claims and medical information.
Recent news reports about St. John's wort underscore the need for caution. New studies suggest that the herbal remedy may interfere with drugs prescribed in a number of situations, including HIV infections, heart conditions, asthma, birth control, and anti-rejection treatments for patients undergoing organ transplant operations.
"There are many herbal products that are safe for patients to use, but there can also be toxicities, complications and interactions patients may not know about," says Dr. Hardy. "Patients should feel comfortable taking anything that looks like a good product or good information to their health-care professional. They can look at the information from their perspective and help ensure that it is used in the most appropriate way for each patient personally."
So, if you're thinking about giving an alternative product a try, here's Step One: Establish a give-and-take relationship with a medical practitioner before taking a chance.
Step Two: Evaluate all health information very critically. Although the advice of family and friends continues to be the most prevalent factor in a patient's health-care decision-making process, Dr. Hardy says the Internet is playing a growing role in providing information and misinformation.
"Patients used to come in with information taken from books, pages torn out of magazines, or even the circular advertising mailings that came to their homes," she says. "Today, they're waving pages of Internet material at us. Unfortunately, many people believe that if something is in print, it's good. We have to help them critically evaluate the source."
"The Internet's ability to provide instant access to information has allowed people to manage their health more effectively," according to Dr. Hardy. But this unregulated marketplace also fosters questionable products and out-of-proportion claims.
She refers patients to a variety of web sites that can provide helpful and authoritative information, and says she has more confidence in sites that are operated by unbiased, professional organizations than those that are purely commercial, wanting to sell a product.
Most government agency sites are free, unbiased and factual. Among those Dr. Hardy often recommends is a database operated by the National Institutes of Health's Office of Dietary Supplements http://odp.od.nih.gov/ods/databases/databases.html and the Agriculture Research Service's Phytochemical and Ethnobotanical Database http://www.ars-grin.gov/duke.
Among her favorite free sites maintained by advocacy groups: The American Botanical Council (www.herbalgram.org) and the Herb Research Foundation (www.herbs.org).
A site that appears to offer objective data but is geared toward professionals and requires a membership fee can be found at www.naturaldatabase.com.
A free site that does not sell products is at www.consumerlabs.com. Web MD (www.webmd.com) and Whole Health MD (www.wholehealthmd.com) are free but more commercial sites that involve products and sponsors, and therefore may require more critical examination.
"Just because a site is not commercial doesn't necessarily mean the information is good, and just because a site is commercial, doesn't mean it has bad-quality information. I look for some objectivity, reporting both sides of a question. I look for resources that have credibility. They may be backed up by scientific data or list references from professional societies. Also, if something promises too much, I get skeptical and tend to believe they can't deliver anything."
Again, Dr. Hardy suggests using your best judgment, then taking the information to your physician for input. "People are always asking me about one product or another. I looked up one recently and all I could find were people selling it in a multilevel marketing scheme. The only research I could find was either anecdotal or propaganda from the company. So I had to say, 'I've heard the stories. They're interesting but there is no research. I can't find even one study of independent data.' I'm sure miracles happen and spontaneous remissions occur, but I think caution is a note to strike."
Step Three: Know what is in the supplement you want to take. Botanical preparations are not required by the Food and Drug Administration to meet the same stringent safety and efficacy standards set for pharmaceutical drugs but they are required to reach manufacturing standards established by the Dietary Supplement Health and Education Act of 1994.
Herbal medicines cannot claim to heal or cure diseases or conditions. And although control is becoming tighter, the amount and potency of ingredients in supplements are anything but uniform.
For example, the potency of various brands of St. John's wort has ended up under the microscope in recent years. In 1998, The Los Angeles Times reported that in a study commissioned by the newspaper, three of 10 brands of the herbal mood-stabilizer "had no more than about half the potency listed on the label." The Boston Globe announced in January that it had hired two companies to independently test seven St. John's wort products. "We found that there was considerable chemical and biological variation among the products tested."
Dr. Hardy says there may be no guarantees that you're getting what you pay for in an herbal supplement, but there are tell-tale signs she looks for on a label to increase the odds. "I want to see information about the company, something that lets me know it has been around for a while. I want to see that the scientific, botanical name of the herb is there, and I want to know how much is in each capsule. Not all herbs need to be standardized but if they are standardized, it's good to know exactly how they are standardized. I like to see lot numbers and expiration dates as indications that the company has quality control standards. If necessary, I will call the company to find out about their quality control process."
A more complete discussion of the issue can be found in a paperback book written by Logan V. Chamberlain, "What the Labels Won't Tell You: A Consumer Guide to Herbal Supplements."
When shopping for a supplement, Dr. Hardy says quality is not always determined by price. "In The L.A. Times article, one of the cheapest preparations did the best."
Finally, Step Four, which is at least as important as Step One: Get an accurate diagnosis before trying to find a cure. Many diseases and conditions share common symptoms. If you treat yourself for the wrong illness or a specific symptom of a complex disease, you may delay legitimate treatment of a serious underlying problem.
"The greatest danger in self-treatment may be self-diagnosis. If you don't know what you really have, you can't treat it appropriately," says Dr. Hardy. "If you have already established a relationship with a physician or practitioner, they can order the proper medical tests and help you initiate appropriate therapies."
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