Every month I read a number of health publications, and one of my favorites is the Harvard Health Letter. The November issue has an excellent article on a field many doctors do not take seriously... "alternative medicine." The skeptics must have been shocked to learn that Harvard Medical School has recently appointed an internist to direct a research center on this subject.
Why? In part because at least one in three adults in the United States turns to alternative medicine in one form or another - whether it be acupuncture or herbs - to prevent or cure an illness. In 1990, Americans spent $13.7 billion on all such remedies, and in 1996 they spent $3.24 billion on herbs alone.
Physicians obviously have been unaware that so many of their patients have resorted to alternative medicine. According to the survey, 70 percent of those questioned said they'd never told their doctors. Apparently they feared disapproval.
The primary reason why doctors might disapprove of the use of herbs and other natural remedies is because they've seen little scientific data on the subject. The medical profession relies heavily on published research in treating patients. You're not likely to find articles on the efficacy of herbs in the Journal of the American Medical Association, so doctors don't know which plants are harmless and which are harmful.
Some herbologists say that anything that's natural is safe, but anyone who's eaten a toadstool instead of a mushroom knows better - if he's still alive. It's time doctors learned more about alternative medicine so they can evaluate the folk remedies their patients take.
Currently, the FDA classifies herbs as "dietary supplements," so they are not subject to rigorous clinical evaluation for effectiveness and safety. Manufacturers of herbal medicine can advertise the supposed benefits of their wares provided they don't claim the products cure or even prevent specific illnesses. So the patient is on his own when he wanders into a natural food store.
Dr. Eisenberg of the Harvard group recommends safeguards, such as the careful monitoring of your clinical situation if you take herbal medications. He suggests that you take only one remedy at a time so that you will be able to pinpoint any adverse reactions. He also recommends that you ask questions about the herbs before you take them - their value and their potential side effects.
When you think you've just been cured of a backache by eating some green leaves, remember this: It's not always easy to evaluate the effects of medicine on a disease.
When I was training at Johns Hopkins, I had two friends from England - Dennis and Daphne. Dennis was a physician in training, and Daphne, his wife, worked as a secretary to put him through medical school.
They told me about being guinea pigs in an English study of the common cold. They were awarded free trips to Brighton if they used a nasal spray that contained either a harmless substance or one of the cold viruses. The study continued for years, and eventually the results were published. Researchers found that the incubation period of a cold - from the time of exposure to the onset of symptoms - was in some cases two days and in other cases a bit longer. In addition, some colds lasted for 3-4 days and others lasted a week or more. For the duration of the study, Dennis and Daphne took frequent trips to Brighton - when they weren't nursing week-long colds.
Of course there still isn't a cure for the common cold, though there are lots of remedies on the market - including alternative medicines. Consider what you might think of an herbal treatment if you took it the first day. The symptoms would persist, and you'd probably conclude that the substance was worthless. However, if you took it on the sixth or seventh day, when the cold was about to self-destruct, you'd be likely to say, "Gee, this is a miraculous cure. Who needs doctors?"
Neither conclusion would be valid. The natural history of the cold would account for the difference - as Dennis and Daphne proved. A general practitioner from Texas put it this way: "I love to see patients who've had a cold for a week. Whatever I do for them, they're going to get better - and soon."
The same is true of many other symptoms - and this is one reason why herbal medicines are so popular. The human body throws off the ailment, and alternative medicine takes the credit.
Such cases are harmless enough. However, following folk remedies is not always safe. Not too long ago I had a patient with sever high blood pressure and an irregular heartbeat. It took two medications and the passage of time to alleviate his symptoms.
Then he went to a natural foods store and bought some herbs. As he was standing at the cash register, the proprietor of the store told him, "Take this and you can throw away your other medicines."
So he did.
Shortly thereafter his irregular heart action returned, his blood pressure shot sky high, and he came to my office on the verge of a stroke. The moral: Be wary if the provider of alternative remedies advises you to discontinue any regular medicines prescribed by a physician. And tell your doctor if you're taking any herbs or other folk remedies. Chances are, he'll be tolerant of your experimentation.
As for me, I think that in time some of these alternative medicines will prove to be effective. In cardiology (my specialty), foxglove (use to make digitalis) has been prescribed in the treatment of heart failure for 200 years - because it works. Today you can get it in pill form. (I've been growing it in my garden for the past 20 years.)
On the other hand, don't gobble up everything they're hawking in the natural food store. If you're going to be your own doctor, make sure what you ingest will do you no harm. That's the first line in the Hippocratic Oath.
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