Herbal medicine information sources

Essential to any type of effective health care is the availability of objec- tive, unbiased information based on truth and accuracy. Unfortunately, in the case of herbal medicine, many information sources are inaccurate and sensationalize or distort the information they contain. In addition, obtaining reliable information on herbs has become a daunting task because there is an herbal medicine renaissance; information sources abound, including, among many others, news magazines and television, books on paraherbalism and herbalism, scientific and professional journals, and online databases. 26

In the evaluation of the safety and efficacy of drugs, the gold standard is the controlled clinical trial based on scientific methodology in which bias has been eliminated. In a controlled trial, patients in one group receive the investigational drug. Those in the control group usually get either a placebo, a different drug known to be effective, or a different dose of the drug under study. Patients are randomly assigned to either the treatment or the control group in order to eliminate selection bias. In conjunction with randomization, an experimental design feature known as “blind- ing” helps ensure that bias does not distort the results of the study. In a double-blind study, neither the patients nor the investigators know which patients received the investigational drug. Only when the secret assign- ment code is broken do the individuals in the study know which patients were in the treatment or control groups. 27

16 Tyler's herbs of choice: The therapeutic use of phytomedicinals Information on the results of clinical trials is published in peer-

reviewed scientific and professional journals. The peer-review process means that before an article is accepted for publication, it is scrutinized by scientists and professionals working in the same area in order to ensure that the conclusions derived from the results of the study are valid. In addition, peer-reviewed professional journals publish lengthy, detailed observations made by professionals about patients in their care. These patient case histories, although lacking the control-study aspect, provide valuable suggestions of drug effects and potential safety problems.

Books constitute another important and widely used source of information on herbal medicine. The most valuable volumes are those that evaluate the current scientific and professional literature and that sup- ply references to this primary literature. Unfortunately, the majority of the books available fall into the category of paraherbalism. These books run the gamut from glossy, expensive picture books with little accurate therapeutic information to books written by herbal medicine practitio- ners who discuss herbs from the viewpoint of their personal bias rather than on the basis of scientific fact. In general, an important caveat when using any information source is to be particularly cautious if references to the primary literature are lacking. Without these citations, there is no way to check the accuracy of the facts presented.

Finally, a particularly valuable information source on the safety and efficacy of herbs is the German Commission E monographs. They were used extensively in writing this book and are discussed in Chapter 3 .

Formerly, the information in the monographs was not readily available to those who did not read German; however, a complete English translation is now available. 28

These, then, are the basic principles of herbal medicine as they apply to its current practice in the United States. The field is a curious mix- ture of ancient tradition applied to modern conditions without, in many cases, the benefit of modern science and technology. To be totally effective, the traditional practices must eventually be coupled with up-to-date scientific methodology. The reason that has not yet been done, except in certain isolated circumstances, will become clear in the Appendix, which examines the present laws and regulations pertaining to herbs in the United States.

The cooperation between empiricism and science—so urgently needed to bring herbs and phytomedicines into the mainstream of modern medicine—is a subject that has been explored in some depth by B. Lehmann, a German physician. Her conclusion, given here in translation, is especially pertinent and serves as a fitting summary to this chapter on

basic principles 29 :

Chapter one: Basic principles

Phytomedicines, exactly like other medicines, must stand up to the challenge of modern scientific evaluation. They need no special consideration when it comes to the planning and conduct of clinical trials intended to prove their safety and efficacy. The distinctive feature of phytotherapy is its origin, namely, the many years of empirical use of plant drugs. Experience gained during this period should

be taken into account, along with clinical testing, in evaluating the effectiveness of phytomedicines.

In 2005, a Swiss–British study evaluated 110 placebo-controlled homeopathy trials and 110 matched conventional-medicine (allopathy) trials. The authors concluded that the effects seen in placebo-controlled trials of homeopathy are compatible with the placebo hypothesis. In contrast, identical methods demonstrated that the benefits of conventional medicine are unlikely to be explained by unspecific effects. 17

References

1. Tyler, V. E. 1987. The new honest herbal, 53–56. Philadelphia, PA: George F. Stickley. 2. Robbers, J. E., M. K. Speedie, and V. E. Tyler. 1996. Pharmacognosy and pharma- cobiotechnology, 117–119. Baltimore, MD: Williams & Wilkins. 3. Sonnedecker, G. 1976. Kremers and Urdang’s history of pharmacy, 4th ed., 40–42. Philadelphia, PA: J. B. Lippincott Company. 4. Robbers, J. E., M. K. Speedie, and V. E. Tyler. 1996. Pharmacognosy and pharma- cobiotechnology, 155–158. Baltimore, MD: Williams & Wilkins. 5. Ziglar, W. 1979. Whole Foods 2 (4): 48–53. 6. Awang, D. V. C., B. A. Dawson, D. G. Kindack, C. W. Crompton, and S.

Heptinstall. 1991. Journal of Natural Products 54:1516–1521. 7. Foster, S. 1991. Echinacea: Nature’s immune enhancer, 84–92. Rochester, VT: Healing Arts Press. 8. Hobbs, C. 1989. HerbalGram 20:30–33. 9. Tyler, V. E. 1989. Nutrition Forum 6:41–44.

10. Culpeper, N. 1814. Culpeper’s complete herbal and English physician enlarged. London: Richard Evans, 398 pp. 11. Treben, M. 1980. Health through God’s pharmacy. Steyr, Austria: Wilhelm Ennsthaler, 88 pp. 12. Heinerman, J. 1979. The science of herbal medicine, xvi–xxi. Orem, UT: Bi-World Publishers. 13. Weil, A. 1989. Whole Earth Review 64:54–61. 14. Barrett, S., and V. E. Tyler. 1995. American Journal of Health-System Pharmacy

52:1004–1006. 15. Der Marderosian, A. H. 1996. Journal of the American Pharmaceutical Association NS36:317–328. 16. Skolnick, A. A. Journal of the American Medical Association 272:1154–1155.

18 Tyler's herbs of choice: The therapeutic use of phytomedicinals 17. Shang, A., K. Huwiler-Müntener, L. P. Nartey, S. Dörig, J. A. C. Sterne, D.

Pewsner, and M. Egger. 2005. Lancet 366:726–732. 18. Robbers, J. E., M. K. Speedie, and V. E. Tyler. 1996. Pharmacognosy and pharma- cobiotechnology, 11–13. Baltimore, MD: Williams & Wilkins.

19. Awang, D. V. C. 1987. Canadian Pharmaceutical Journal 120:100–104. 20. Welt am Sonntag, March 23, 1997, p. 40. 21. Tyler, V. E. 1996. Journal of the American Pharmaceutical Association

NS36:29–37. 22. Tyler, V. E., and S. Foster. 1996. Herbs and phytomedicinal products. In Handbook of nonprescription drugs, 11th ed., ed. T. R. Covington, 695–713. Washington, D.C.: American Pharmaceutical Association.

23. Klein-Schwartz, W., and B. J. Isetts. 1996. Patient assessment and consulta- tion. In Handbook of nonprescription drugs, 11th ed., ed. T. R. Covington, 11–20. Washington, D.C.: American Pharmaceutical Association. .

24. Robbers, J. E., M. K. Speedie, and V. E. Tyler. 1996. Pharmacognosy and pharma- cobiotechnology, 87. Baltimore, MD: Williams & Wilkins. 25. Reich, I., E. T. Sugita, and R. L. Schnaare. 1995. Metrology and calculation. In Remington: The science and practice of pharmacy, 19th ed., ed. A. R. Gennaro, 63–73. Easton, PA: Mack Publishing Company.

26. Hoffman, E. 1994. The information sourcebook of herbal medicine, 1–60. Freedom, CA: The Crossing Press. 27. Flieger, K. 1995. Testing drugs in people. In From test tube to patient: New drug development in the United States, 6–11. FDA Consumer Special Report, DHHS pub. no. FDA 95–3168. Rockville, MD: Department of Health and Human Services.

28. Blumenthal, M., W. R. Busse, A. Goldberg, T. Hall, C. W. Riggins, and R. S. Rister, eds. 1998. The complete German Commission E monographs: Therapeutic guide to herbal medicines, trans. S. Klein and R. S. Rister. Austin, TX: American Botanical Council.

29. Lehmann, B. 1992. Zeitschrift für Phytotherapie 13:14–18.

chapter two

Herbal medicine information sources