(originally posted 5 March, reposted here)
Although it was broadcast a few weeks ago, finally got around to watching the last episode of BBC2's "Alternative Medicine - the evidence", on herbalism.
(http://www.open2.net/alternativemedicine/programme3.html)
For me the debate about herbalism is more than just a simple question of whether certain herbs have medicinal effect or not, but also says something about how science fits in to our modern society, in people's perceptions, and in practice.
While people are right to be always a bit sceptical about all claims, scientific or otherwise, I find it worrying that in the area of health people are often so ready to think that something which is not manufactured is therefore more 'natural' and thus always better.
Being honest, I find 'natural' an oft abused and even incoherent concept. Not everything on this planet has always existed, or at least in it's current shape and form, so what is 'natural' will always have an element of parochial prejudice about it - what is natural for us might have been modern for previous ages, and so on. Natural in the sense of 'naturally occuring' is perhaps what is generally meant, but this hides an important shift in emphasis from what something is, to where it comes from. Any chemical, especially a medicine, must be judged by what it is, and more specifically how it behaves, rather than by where it comes from. Just because something is produced in a lab does not make it bad, in fact it is more often than not a purified and carefully controlled version of something first seen in nature. Nor is something good simply because it is 'found' in nature - as the many naturally occuring poisons and toxins show. The poppy gives us morphine, but can also be heroine. 'Natural' can be beneficial and dangerous at the same time.
That doesn't mean I always think artificial is best. For example in the realm of nutrition, I am often of the opinion that supplements etc. cannot compare with eating the plants that contain the substances being copied. But this is not because the substances are somehow more 'natural' in the plants, the substance is the same whether created in a lab or a lettuce, but I am not convinced that all the necessary substances are being supplemented, or that their combinational effect is the same as in the plant.
With nutrition, there are very good reasons why the thing itself can be relied upon - because our bodies have adapted to use the plant, and therefore the two are perfectly matched. Of course it is in theory possible to make supplements that provide everything without the hassle of eating a lettuce, but given the likelihood that something is being lost, it's easier to just have a salad.
Similarly it is possible that a supplement might be actually better than what is found in the plant - and some how 'hyper-stimulate' some beneficial function, but the odds are against it. Our gut has been doing trials with the lettuce for millenia, longer than any lab has been going.
However there is an important reason why this argument does not apply to medicine. The fact that for most of our history we had to survive on unprocessed plants necessarily shows we are adapted to live off these plants. If we weren't, we wouldn't be here. The same reasoning cannot be applied to the use of plants in medicine, since there is not the evolutionary dependence involved. Non-instinctive usage of herbs must rely on the existence of culture, and even language, which does not leave enough evolutionary time available. Given in addition the isolation of original cultures, even from a cultural evolutionary perspective this is unfeasible. While it might be possible that the usage of plant X consistently in a group might favour a gene pool which had positive reactions to plant X, the time and isolation of groups in earlier history would make it highly unlikely that the same gene pressure would exist in humanity at large. An example of how different groups handle natural substances differently is lactose intolerance - which while widespread throughout humanity is more predominant in certain ethnic groups, groups which in there history did not perhaps rely on dairy products as much as for example Europeans. Even with foodstuffs, while there are plenty of very beneficial plants out there, it is science and research more than human tradition which tells us nowadays which of them are most beneficial. For a long time red meat was traditionally seen as a healthier, supperior food, but this was largely due to its relative expense, and the assumption that the more something cost the better it was. There is more to our co-evolution with our food than human tradition can tell us alone.
And of course it it can be said that the very point of medicines is to counteract what might be viewed as 'natural' events - sickness and ultimately death are the most natural things describable - all part of the cycle of life. But in medicine mankind is trying to 'improve' on nature i.e. change the course of nature to something it thinks is 'better' - namely longer and healthier life. When people talk about preferring a 'natural' birth, they should realise that 'naturally' 75% of children wouldn't reach adulthood. What is very very natural in this case could hardly be considered 'good' by anyone. The evolutionary cycle only helps us long enough to reproduce. For things after or outside of this, we must often turn to our own devices.
There are 2 types of medicine, that which works, and that which doesn't
This is of course not to deny that some herbs work, perhaps in some cases better than currently available modern medicines. But the point which worries me is that people often forget they are not better because they are herbs, but they are better if they can be shown to work, and without side effects. And if a herb is studied and understood to the point which this happens, then it can (and should) be artificially reproduced, its dosages controlled, and it become a cure. Until that happens it is NOT a cure, but a 'guess' at one....perhaps an informed guess, based on tradition, but a guess nonetheless. For me medicines mean substances which have been scientifically shown to be real cures, if not perfect or absolute ones.
The basic point is that for something to be a true medicine, something which we should use on ourselves to improve our health, it has to be known (i.e. shown) to have a positive effect. And 'tradition' while a good indicator of starting points for research, is on it's own not a reliable enough source of knowledge, especially since if something is strong enough to have an effect, it is strong enough to have a bad effect (and if it is not strong enough to have an effect, there is no point in taking it).
And of course what is a 'good' effect is something that must be objectively decided, and the only way to do this is by trials which study the changes, both regarding the ailment to be cured, and any possible side effects. Of course this applies to modern drugs as well, which is why there are such trials. But in the case of modern drugs there is much more regulation, not least because the companies behind them can be sued. Perhaps it is the lack of legal responsibility ('Nature' can't be sued) that leads to the lack of such rigourous regulation in the herbal area....though there are no health-related reasons why there should not be. Anything is dangerous if not studied, regardless where it comes from.
Some work, so why so many neglected?
The most interesting thing that arose for me out of the programme, was not the fact that herbalism is on the rise in the modern world, but that the whole area seemed to be so neglected by modern research. One would have thought that if there are some herbs which have some promising effects, then it would be in the interests of both society and industry to study and isolate, and commercialize the active ingredients. First of all there is a very real danger that active substances are being supplied and consumed with out real knowledge about how and why they work. Second of all, and more tragic and incomprehensible, is how many possible new leads in not only substances but how their combinations function, is being ignored.
There are two possible and depressing reasons which might contribute to this state of affairs. Firstly, proper research is such a costly and time consuming exercise, that the bulk of it is probably only done by well financed sources, namely the pharmaceutical companies. As a result, the necessary sums will only be invested if the returns will be profitable. This means it will always be the big western conditions which will be targetted primarily, since it is this market which will fork out for the final products. In addition, most herbal remedies do not claim or seem to be particularly strong - and a lot held by 'mild relief' from symptoms for everyday annoyances rather than life-threatening diseases - and it might be that such ills do not generate the necessary revenue. While there is commercial potential for a drug that 'completely' relieves pain - is there the same market for ones that 'slightly' relieve symptoms? Perhaps, but the business case is not as strong - if i have a debilitating headache I am likely to pay more than if I have a midly irritating rash.
But some herbal claims do target really important diseases - in the programme there was an example of a herb in South Africe being (seemingly successfully) used to care for AIDS patients. So why are such herbs being heavily researched? The second reason, also quite skeptical, is that perhap there is not the same potential for 'owning' a natural remedy if one spends a lot of time and money showing it to be effective. It is understandable that big business won't basically waste it's money on studying how good something is that can be found outside everyone's door....but it is less understandable why society as whole doesn't.
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