Many people think of herbs and home remedies as quaint, old-fashioned byproducts of prior centuries. Modern-day pharmaceuticals seem far more scientific. Commercials on television make medications appear to be the answer to virtually all our ailments. Is there a place for home and herbal remedies in the 21st century?
Evidence-Based Medicine vs. Home and Herbal Remedies
We frequently hear from people who say that their health professionals are scornful or dismissive of home remedies or “alternative” therapies such as herbs or dietary supplements. It’s not surprising. Such approaches are not taught in most schools of pharmacy or medical schools.
Pharmacists and physicians like to pride themselves on their scientific approach to healthcare. The phrase that has been embraced for the last two decades is “evidence-based medicine” (BMJ, Jan. 13, 1996).
What is Evidence-Based Medicine?
It usually refers to a reliance on randomized, double-blind, placebo-controlled trials. These are the gold standard for proving drug effectiveness.
We’re enthusiastic about such research. It reduces psychological factors such as expectations or opinions. But it can be taken to extremes. A brilliant, tongue-in-cheek article in the BMJ (Dec. 13, 2018) was titled:
“Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial”
The authors introduce their mischievous article this way:
“Parachutes are routinely used to prevent death or major traumatic injury among individuals jumping from aircraft. However, evidence supporting the efficacy of parachutes is weak and guideline recommendations for their use are principally based on biological plausibility and expert opinion.
“Previous attempts to evaluate parachute use in a randomized setting have not been undertaken owing to both ethical and practical concerns. Lack of equipoise could inhibit recruitment of participants in such a trial.”
The “researchers” go on to note:
“Although decades of anecdotal experience have suggested that parachute use during jumps from aircraft can save lives, these observations are vulnerable to selection bias and confounding. Indeed, in seminal work published in the BMJ in 2003, a systematic search by Smith and Pell for randomized clinical trials evaluating the efficacy of parachutes during gravitational challenge yielded no published studies.”
These scientists had a lot of fun writing this article. You will get a chuckle too. Here is a link to the full text in the BMJ.
Common Sense and Observation:
The point we would like to make about randomized controlled trials is that sometimes “biological plausibility and expert opinion” are all that is needed. Common sense and observation also play a role.
If your hiccups instantly go away after swallowing a teaspoonful of granulated sugar, that’s worth something. Ditto for leg cramps that cease shortly after a person swallows a teaspoon of yellow mustard. Do you need a randomized controlled trial if the pain from a minor household burn goes away immediately after dipping the affected skin in soy sauce?
Seeking a “Mechanism of Action:”
Many health care professionals reject home and herbal remedies out of hand. They don’t even ask whether there is any evidence for effectiveness. They insist upon a “mechanism of action” that they can understand. Many physicians assume that this is what they find with most pharmaceuticals.
Little do they realize that the mechanism of action for many commonly used drugs is not known. Do they then refuse to utilize these treatments?
How Does Abilify Work?
For example, the professional information on the widely prescribed antipsychotic drug aripiprazole (Abilify) reads:
“The mechanism of action of aripiprazole in schizophrenia or bipolar mania, is unknown.”
To be fair, this statement precedes an explanation of how it might work.
How Does Ashwagandha Work?
How different is that from the admission, in a description of a study of Withania somnifera (WSE or Ashwagandha), that:
“the mechanism of its efficacy requires more exploration”? (Annals of Clinical Psychiatry, May 2019).
By the way, that appeared in a report on a placebo-controlled trial finding that Ashwagandha alleviated depression and anxiety among people with schizophrenia. We suspect that some psychiatrists who would readily prescribe Abilify would not even contemplate recommending Ashwagandha.
Drugs Work Even if We Don’t Know Why:
There are hundreds of medications for which the mechanism of action remains mysterious. Levetiracetam (Keppra) is an anticonvulsant. The official prescribing information states:
“The precise mechanism(s) by which levetiracetam exerts its antiepileptic effect is unknown.”
Ask any neurologist, though, and she will tell you that levetiracetam works very well to control epilepsy in many patients.
Home and Herbal Remedies That Work:
Moreover, a surprising number of home remedies and herbs actually have scientific explanations. For example, gout specialists have been known to scoff at the idea that tart cherry juice might help this painful condition.
They prefer to prescribe drugs that lower uric acid levels in the bloodstream. A buildup of uric acid crystals is responsible for the joint pain and inflammation behind gout.
They may not be aware of a randomized, placebo-controlled crossover study involving tart cherry juice (Current Developments in Nutrition, Feb. 25, 2019). Tart cherry juice significantly reduced serum uric acid levels and inflammation.
Other research demonstrates that both sweet and tart cherries can inhibit the inflammatory compounds COX-1 and COX-2. These are the same enzymes affected by nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen, diclofenac and meloxicam. Studies have also found that cherry products can alleviate arthritis pain, ease exercise-induced muscle soreness and improve sleep (Nutrients, March 17, 2018).
The Science Behind Home and Herbal Remedies:
We love science. That’s why we interview authorities with impeccable credentials. In Show 1079: What Is the Science Behind Fabulous Foods for Health? we talked to Tod Cooperman, MD, founder and president of ConsumerLab.com about olive oil. We also interviewed Ajay Goel, PhD, director of the Center for Gastrointestinal Research and of the Center for Translational Genomics and Oncology at the Baylor Scott & White Research Institute. He is professor of medicine at Baylor University Medical Center. Dr. Goel discussed the science behind using turmeric as a medicinal food.
Another guest on Show 1079 was Malachy P. McHugh, PhD. He has been the Director of Research at the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT) at Lenox Hill Hospital in New York City since 1999. He leads a multidisciplinary research team including orthopaedic surgeons, physical therapists, exercise physiologists, nutritionists, biomechanists, biomedical engineers, and athletic trainers.
Dr. McHugh is am impeccable scientist. Find out how his well-controlled studies demonstrate benefits thanks to Montmorency cherry juice at this link (Journal of the International Society of Sports Nutrition May 11, 2015) Better yet, listen to our interview with Dr. McHugh during the last segment of this radio show. We think it is a thoughtful, scientifically sound discussion of cherry juice against inflammation.
Why Is Google burying Home and Herbal Remedies?
For reasons that are obscure to us, Google has determined that many websites featuring home and herbal remedies do not deserve visibility. They have virtually disappeared from Google’s search process. That includes a lot of content from The People’s Pharmacy. Read more about what has happened and what you can do about it at this link:
Do you Like Home and Herbal Remedies?
People who appreciate the science behind many home and herbal remedies will find our eGuide to Favorite Home Remedies of interest.
What do you think of home and herbal remedies? Are they worthless and a waste of time or have you found them helpful? Do you agree with Google that alternative health websites should be stifled? Please share your thoughts in the comment section.