You will be hearing a lot in the news about alternative medicines – the regulation of Herbalists, which we have been campaigning for; and a lot of issues about Homeopathy, the NHS and whether funding should continue into this treatment.
As you can see from other posts, we are herbalists not homeopaths (read here) but this idea of proof and efficacy affects us too.
Opponents of Herbal Medicine
In an article in the Independent (January 5th 2010) in which Hayley Jones of Foreman & Jones was interviewed (link here), Edzard Ernst, one of herbal medicine’s main opponents said ‘It is important to realise that herbs are pharmacologically active compounds and can cause harm and sometimes even kill…. we have reviewed the work published [on the way in which herbalists treat patients on an individual basis] and conclude there is no evidence that this type of herbalism does more good than harm. That is to say, the potential for harm is greater than the potential for good.’
How do you test a Natural Medicine like an individually-prescribed Herbal Medicine?
Now we obviously do not hold a lot of stock in his statements otherwise we would not be publishing them on our website! Opponents of herbal medicine usually want its efficacy to be proven using double-blind placebo controlled trials. This means that a group of patients all with ‘the same illness’ are split into two groups. One group is given the medication that is being tested and one group is given a placebo (that resembles the medicine but is thought to be inert – ie sugar pills) and no one taking part in the experiment knows which group is taking the drug and which group is taking the placebo, not even the experimenters themselves. The patient progress is then evaluated, and the results are taken away and evaluated statistically to see if there is any statistical significance to the results.
The problem with this approach is that herbal medicine does not fit into this model. For us, taking herbal medicines is not only about the medicine that you take (otherwise we’d administer our herbs through a coin-operated slot in the wall!) but it is also about getting to know and understand the patient, so that we can dispense an individually prescribed medicine that gives that patient just what they need. If there are any other issues that the patient wishes to speak about then we talk to them about those and we also advise on diet and lifestyle. The patients who come to see us are usually disillusioned with that approach of a minimal consultation, being handed a prescription and going off taking a one-size-fits-all drug. Many of the patients we see have been everywhere else before they come to us for help. They come to us because they want a personal approach, one in which they are important.
What is Good Evidence?
When it comes to evidence base, many people have taken the narrow view that Ernst has of double-blind placebo controlled trials. Whereas the original definition of the term (proposed by its originator Sackett) spoke of evidence-based medicine meaning:
“integrating individual clinical expertise with the best available clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgement that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients’ predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens.
Sackett also said:
“Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients”.
This is very much what we feel at Foreman & Jones. The way that we continually improve on our knowledge in our field is to continue to study the literature – both new and old, and integrate that with the experiences that we have with our patients.
I am very much of the belief that current scientific knowledge does not hold all the answers – there are many things that are unknown and that we do not understand, but simply because we do not understand them does not mean that they do not work or happen.
Mainstream Medicine and Evidence of Efficacy
It is also true that mainstream medical practice is not rooted in an established evidence base of evidence-based medicine (EBM). This can be seen in recent editorial from the BMJ Journal Evidence Based Medicine. It said:
“When it comes to older treatments, there is often a gap between empirical evidence, clinical practice, and patient experience. Moreover, there are conspicuous double standards in attitudes to older treatments. For example, about half of all so-called conventional healthcare interventions continue to be used even though research on their efficacy is non-existent or equivocal. By contrast, traditional complementary and alternative therapies that have been widely used for many years and continue to be popular with patients are regularly dismissed out of hand on the grounds that there is little ’scientific’ evidence to confirm whether they work.
Less obviously, and more controversially, there are questions about whether the pharmacological randomised controlled trial model for research is sufficient to assess long-established interventions. One concern is that, because many of these interventions comprise several components, the individual effects of which may be hard to isolate and measure separately (e.g. palliative care, public health, or many complementary and alternative therapies), artificially standardising them to fit a drug-trial model may involve over-simplification. This will then raise questions about the real-world applicability of the study results. Accordingly, there is an argument for a different type of research strategy for long-established interventions, with a different order of priority…”
46% of Medical Treatments have unknown effectiveness – BMJ
There is some fascinating data recently published in the BMJ’s online Journal Clinical Evidence. It shows that far from having a complete evidence base, only about 13% of 2,500 medical treatments surveyed are rated as beneficial with 46% “of unknown effectiveness”
“So what can Clinical Evidence tell us about the state of our current knowledge? What proportion of commonly used treatments are supported by good evidence, what proportion should not be used or used only with caution, and how big are the gaps in our knowledge? Of around 2500 treatments covered 13% are rated as beneficial, 23% likely to be beneficial, 8% as trade off between benefits and harms, 6% unlikely to be beneficial, 4% likely to be ineffective or harmful, and 46%, the largest proportion, as unknown effectiveness. Dividing treatments into categories is never easy hence our reliance on our large team of experienced information specialists, editors, peer reviewers and expert authors… However, the figures above suggest that the research community has a large task ahead and that most decisions about treatments still rest on the individual judgements of clinicians and patients.”
We were made aware of this data by our friend and colleague Michael McIntyre MNIMH who is often interviewed on the subject of the statutory regulation of herbalists, and were very interested indeed to hear that there are in fact double standards being applied here.
Choice for All when it comes to Healthcare
We are never out to rubbish orthodox medicine – we feel that a broad choice of medical treatments should be available to all, and that not every approach suits every person – we just feel that there needs to be a level playing field when it comes to discussing efficacy. We all know that research costs a lot of money and there are not quite the same financial benefits in researching herbal medicines as there are for the next new big drug.
We would not have put a combined 8 years of degree training and 16 years in practice into a profession in which we did not whole-heartedly believe benefits our patients. We implore the wider scientific community to begin to structure research methods that fit the therapy rather than trying to squeeze disciplines of all shapes and sizes into the one, very small box.
Hayley Jones BSc (Hons) MNIMH GHR Reg.
Medical Herbalist, Hypnotherapist and NLP Master Practitioner
Image: m_bartosch / FreeDigitalPhotos.net
Related posts:
- Local Herbalists quoted in the Independent on the subject of Herbal Regulation The subject of the regulation of herbalists continues. We local...
- Herbal Medicine Regulation For ten years we have been working towards the statutory...
- NIMH gives cautious welcome to Secretary of State for Health’s announcement on Statutory Regulation of herbal medicine Secretary of State Andy Burnham has announced that statutory regulation...
- Update on the Regulation Process The Latest Regulation News Today we have received news that...
- Natural Medicine for the 21st Century To many people, herbal medicine is something new – less...
Related posts brought to you by Yet Another Related Posts Plugin.
Herbal Products
