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Alternative Medicines

As nonconventional medical treatments become increasingly mainstream, we take a look at the science behind some of the most popular.

By | July 1, 2012

GETTYIMAGES, BARBARA BELLINGHAM

While traveling in China in 1971, two-time Pulitzer Prize-winning journalist James Reston underwent an emergency appendectomy, after which Chinese medical personnel treated his pain with acupuncture. His description of the experience in the pages of the New York Times brought the practice of traditional Chinese medicine front and center.

Two years later, Lewis Thomas, then president of Memorial Sloan-Kettering Cancer Center, delivered an address in which he said, “These are bad times for reason, all around. Suddenly, all of the major ills are being coped with by acupuncture. If not acupuncture, it is apricot pits.” Thomas was referring to laetrile, a compound extracted from the pits of apricots and bitter almonds, one of the most sought-after alternative treatments for cancer at the time, but one whose effectiveness had been the topic of bitter controversy for years. Banned since 1963 in the U.S., laetrile is reported to still be readily available in the Bahamas and Mexico and is sold online.

And the examples don’t end there. Lots of ballyhoo, head-scratching, and accusations of quackery attended growing patient demand for alternative treatments, hyped in the popular press as cures that were “natural” and based on millennia-old medical traditions practiced in places such as China and India.

In 1999, in response to a growing outcry for some kind of evidence-based scientific analysis of the safety and efficacy of this blizzard of nonconventional treatments, the National Institutes of Health, then under the direction of Harold Varmus, established the National Center for Complementary and Alternative Medicine (NCCAM). Since its founding, NCCAM has funded basic and clinical research at institutions around the world on plant and animal products such as acai, black cohosh, gingko biloba, and shark cartilage, as well as on the therapeutic value of treatments including acupuncture, yoga, massage, reiki, and meditation.

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Almost 40 percent of US adults and 12 percent of US children have used complementary or alternative therapies, according to a 2007 survey by NCCAM, and much of what was once considered “alternative,” including acupuncture, is now part of more-holistic regimens offered at 40 percent of US hospitals, including Memorial Sloan-Kettering Cancer Center. According to a 2010 survey by the American Hospital Association and the Samueli Institute, a nonprofit center for the study of wellness and healing, this trend is driven by patients demanding alternative or complementary treatment options for conditions that are difficult to manage or cure, such as diabetes, chronic pain, and cancer. Most physicians have l­ukewarmly embraced such therapies, often because they feel that patients will desert conventional therapy out of desperation if they are not offered a wider range of treatment options.

Researchers who study the scientific validity of nonconventional treatments rarely see them as stand-alone remedies, preferring to call the union of conventional and nonconventional “integrated therapy.”

The Scientist staff asked experts about the scientific evidence for a number of treatments that may be on the verge of becoming incorporated into integrated therapies, from acupuncture and probiotics to marijuana and psychedelics. We sought to highlight the data that either supports or contravenes the effectiveness of these alternative therapies. As with most health interventions, we uncovered both positive and negative aspects of these treatments for which patients are clamoring and physicians are demanding evidence.
—Mary Beth Aberlin


 

Though research is deepening our understanding of the role of microbes in our health, good clinical trials are still needed before consumers can be sure they will enjoy any benefits.

Microbes, mostly bacteria and yeast, teem throughout our bodies, setting up their own ecosystems on our skin and in our mouths and guts. As it becomes ever clearer that microbial ecosystems are intimately connected to our health, consumers look to probiotics—strains of bacteria or yeast that may have health benefits if ingested or applied externally—as gentler alternatives to current therapies. Beyond the obvious interest in developing probiotic treatments for gastrointestinal disorders, researchers hope to understand how probiotics may influence obesity, skin health, vaginal health, and even our moods. With probiotics showing up in everything from yogurt to face cream, it’s difficult to know whether these products have credible benefits. Clinical studies are beginning to support the early promise of some probiotic treatments, and scientists are rapidly expanding their knowledge of how microbes interact with our bodies and how probiotics might be rationally employed both to treat and to prevent disease.

“It’s a very exciting time to be a microbiologist,” says Maria Marco of the University of California, Davis, who studies how lactic acid bacteria, which include strains used in milk fermentation, interact with our intestines to improve health. She points to a confluence of genetic data from the Human Microbiome Project and experimental data, which together are beginning to illuminate the role of microbes in health.

Kefir grains
Kefir grains
DIMITRIS STEPHANIDES

About 200 clinical trials have investigated the use of probiotics to treat gastrointestinal disorders, and the science is finally catching up to the hype, says Marco. A March 2011 Cochrane Review recommended the use of probiotics in premature babies to help prevent necrotizing enterocolitis, in which sections of bowel tissue die. In November 2011 another Cochrane Review of 16 studies reported efficacy in treating children with probiotics to prevent antibiotic-associated diarrhea. But the evidence is not overwhelmingly positive, notes Matthew Ciorba, a gastroenterologist at Washington University in St. Louis. “If there were super-strong results, all physicians would be prescribing [them],” Ciorba says. The Cochrane study showed that probiotic treatment reduced antibiotic-associated diarrhea from more than 220 cases per 1,000 children to fewer than 90. But the review’s lead author, Bradley Johnston at the University of Toronto’s Hospital for Sick Children, explains that due to a lack of high-quality data, he and his coauthors are not extremely confident about those numbers. About 25 percent of patients did not complete the studies, and even though they collected data from 3,000 children, there were relatively few cases of diarrhea, making it difficult to draw strong conclusions.

Another antibiotic-associated infection that is on the rise, the occasionally life-threatening Clostridium difficile, may be amenable to probiotic treatment, but again, rock-solid results are lacking. One reason for the dearth of convincing clinical trials, Johnston notes, is that it’s more difficult to conduct trials for a rare disease like C. diff, because they require larger numbers of base participants to catch the rare cases needed to power the study. A 2008 meta-analysis examining probiotic treatment of C. diff infection did not recommend the therapy, but Johnston says that an updated analysis is expected to be completed this summer. Fecal transplants of healthy-donor gut microbes—also considered a probiotic treatment—have shown promise in case studies of C. diff, but clinical trials are needed. Investigations of the probiotic potential of Saccharomyces boulardii, closely related to brewer’s yeast, and Lactobacillus rhamnosus GG have produced mixed results, but suggest that both may aid in treating recurrent C. diff infections. Johnston expects to see more strain-specific trials for this hospital-acquired infection in the future. (See “Wrestling with Recurrent Infections,” The Scientist, May 2011.)

Trials investigating probiotic treatment of chronic inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, have so far failed to demonstrate a strong effect. A 2011 Cochrane Review of four clinical trials surveying probiotic treatment of ulcerative colitis couldn’t recommend the therapy due to a lack of large, well-designed, randomized trials. The pooled studies covered only 587 participants; two trials were not completely blinded; and one had a dropout rate of nearly 50 percent.

It’s clear that larger and better-designed studies are necessary, but researchers are also contending with microbial ecosystems that aren’t easily altered. “Our microbes are fairly established,” says Mary Ellen Sanders, of Dairy and Food Culture Technologies in Colorado. “They can be perturbed [with new probiotics or pathogenic strains] but they tend to bounce back,” so eating yogurt won’t permanently colonize the gut with beneficial bacteria. Thus, chronic problems stemming from a specific spectrum of microbes—unlike antibiotic-associated diarrhea—will be unlikely to respond to a quick dose of probiotics.

Lackluster trial results may also stem from using the wrong probiotic to treat an illness. Specific probiotic strains may have drastically different effects, even if the microbes are from the same species, explains Marco. Her own work on the immunomodulatory effects of Lactobacillus plantarum on human immune cells showed that production of the pro-inflammatory cytokine IL-12 differed up to 16-fold based on the strain, and the amount of the anti-inflammatory cytokine IL-10 differed 14-fold. Immunomodulation is one key mechanism thought to underlie probiotic effects. Cell-wall components of probiotics, such as peptidoglycans and teichoic acids, can spur pro- or anti-inflammatory reactions from mucosal and immune cells, depending on modifications like glycosylation and acetylation. A strain of L. plantarum that promotes more IL-10 production has been shown to protect against colitis in a mouse model.

Although controlling inflammation is thought to be one mechanism, how, exactly, probiotics work against conditions such as antibiotic-induced diarrhea is unclear, says Gregor Reid, a microbiologist at the University of Western Ontario who helped write the World Health Organization’s definition of probiotics 10 years ago. It’s known that commensal (nonpathogenic) microbes can stimulate mucus or antimicrobial peptide production by gut epithelial cells, Reid explains, and probiotics might also compete with pathogenic bacteria for an ecological niche.

One future challenge will be translating promising animal studies into effective human trials, says Sanders. For example, she notes, probiotics “give really nice results” in mouse models of Crohn’s disease, but so far attempts to replicate this in humans have fallen short.

Researchers are also beginning to tackle the question of how probiotics may help in conditions seemingly unrelated to our guts, such as periodontal disease, allergic disorders, and even mental health. It’s known that our microbial ecosystems are in flux for several months after birth, and if certain strains are linked to later disease, like asthma, early manipulation of our microbiota might be a wise prophylactic strategy, says Reid. Sanders, in turn, postulates that the Human Microbiome Project may provide us with information that will help us identify the right microbes to help infants and children develop appropriately. Research linking obesity or stress responses to the gut microbiome is in tantalizing early stages. Marco points to one study in which probiotic treatment influenced mouse stress behaviors, and several which suggest that gut microbes may influence energy expenditure and abdominal fat.

In the meantime, says Ciorba, it remains difficult for the consumer to benefit from successful probiotics studies. Even if a yogurt contains a probiotic strain that is backed by scientific research, it’s difficult to know how the viability of the commercial strain compares to the doses tested in the lab or how long it should be taken for optimal effect. Touching again on the notion that our intestinal health may influence our mental health, Ciorba points to irritable bowel syndrome—a constellation of generally mild symptoms that may be difficult to measure clinically. Though probiotic treatment may not change the amount of diarrhea or timing of bowel movements, patients still report improvements in pain symptoms. When taking probiotics, Ciorba says, “they just feel better.”
—Sabrina Richards


 

Acupuncture may not work any better than its placebo, but even the placebo often improves patient outcomes.

In 1997, the National Institutes of Health convened a conference to evaluate acupuncture—the insertion of needles into the skin at points that run along so-called meridian lines outlined by Chinese traditional medicine—with the goal of determining whether the technique had a place in Western medicine. The practice is used to treat a wide range of conditions, from pain to infertility, epilepsy and schizophrenia, and the NIH consensus conference was tasked with determining if the claims were valid. “A consensus conference is more like a court of law than a scientific meeting,” explains Richard Hammerschlag, Emeritus Dean of Research at Oregon College of Oriental Medicine, who presented at the meeting. “At that point, there was relatively little good research. Most of the studies were underpowered, low-sample studies.”

Twelve professionals from fields including anthropology, psychiatry, public health, osteopathic medicine, and substance abuse evaluated the presentations, and at the end of the conference drafted a report summarizing their collective opinion.

Despite the limited data available, and the panel’s rather hedged wording, the conference report found that there was enough evidence to support the use of acupuncture for post-operative dental pain and for nausea after chemotherapy, and evidence for several other applications that seemed promising. The conference report, which was published in the Journal of the American Medical Association, lent an air of validity to the use of acupuncture. “I think it was considered a milestone in accepting acupuncture in medical practice,” says Eric Manheimer, an administrator of the Cochrane Collaboration’s Complementary Medicine Field.

Acupuncture model
Acupuncture model
ROBERTO A SANCHEZ

5 years and some 4,000 clinical trials later, researchers are still not convinced that acupuncture is any better than the often-used placebo of sham acupuncture, which employs only superficial needle insertion into random points on the skin. The confounding issue, and the one which most researchers seem to agree on, is that both acupuncture and sham treatment appear to have benefits over the standard of care, creating what researchers call the “efficacy paradox.” It suggests that either acupuncture exerts a powerful but reproducible placebo effect in patients, or that inserting needles randomly has the same effect as inserting needles into some 400 acupuncture points that traditional Chinese practitioners believe help unblock one’s qi, or life force.

Researchers studying placebo effects have demonstrated that acupuncture can go a long way towards helping patients feel better. One recent study by placebo researcher Ted Kaptchuk at Beth Israel Deaconess Medical Center compared albuterol, an asthma medication, with sham acupuncture, no intervention, or a placebo inhaler (NEJM, 365:119-26, 2011). Patients reported feeling better after albuterol treatment, as well as after sham acupuncture and the placebo inhaler, but not if they received no treatment at all. However, when researchers took an objective measure of their asthma—the maximum forced expiratory volume in one second—it was clear that only those treated with albuterol actually improved.

In another study, participants were asked to rate their belief that acupuncture would work prior to acupuncture treatment for pain. Those with high expectations showed greater pain relief than those with lower expectations, regardless of whether they received real or sham acupuncture (Pain, 128:264-71, 2007). While the research suggests that there is a strong placebo component to acupuncture, that may not be a bad thing, says acupuncture practitioner and placebo researcher Tao Liu, a visiting scholar at the University of Maryland School of Medicine. “Placebo effects can be clinically relevant and can be harnessed to improve patient care. Acupuncture is a good example,” Liu says in an e-mail.

Another possible explanation for the efficacy paradox touches on the fact that researchers still don’t have a good idea what acupuncture’s mechanism of action might be, which makes it extremely difficult to create an appropriate control. “That was the problem [in 1997] and is still the problem today,” says Hammerschlag. When drug trials are performed to test efficacy, “you know what the real drug’s mechanism is—how it’s absorbed, how it’s metabolized, and how it’s degraded,” he says. That knowledge allows researchers to design a placebo that doesn’t do any of those things, but that mimics the treatment enough to deceive the patient. Some sham acupuncture trials use methods such as poking a person with the blunt end of the needle or using placebo needles which retract into the handle of the needle, but these can be too easy for a patient to spot, rendering the placebo ineffective.  Real needles superficially inserted into the skin at nonmeridian points are harder for patients to differentiate from “true” acupuncture, but some researchers think that even apart from patients’ belief that they are getting the real thing, this placebo could still activate the same mechanism of action as needles inserted into the traditional meridian points.

While there is no agreement on how acupuncture might work, a number of physiological changes do occur as a result of acupuncture needling, both in animal models and in humans, along meridian lines or not, which may or may not be related to acupuncture’s proposed medicinal effects. For example, studies in mice suggest that acupuncture’s reported effect of relieving pain may be mediated by the localized release of adenosine, which has analgesic effects (Nat Neurosci, 13:883-88, 2010). Other studies show that connective tissue in mice sticks to acupuncture needles and measurably wraps around the needle, which stretches the tissue. As a result of this stretching, nearby fibroblasts become enlarged and, over the course of 30 minutes, cause the connective tissue to relax. Simple mechanical stretching of the connective tissue appears to have the same effect on fibroblasts, but acupuncture provides a way of creating a local and sustained stretch, says Helene Langevin, a neuroscientist who studies connective tissue and mechanotransduction at the University of Vermont. But, she says, “we don’t know how that translates to changes in pain [perception]. We haven’t tested that yet.”

Although the question of whether acupuncture helps patients due to a placebo effect or an actual physiological change remains open, a number of insurance companies both in the United States and in the United Kingdom have begun to cover the practice, at least for a few conditions, such as lower back pain. Whether it works for the right reasons or the wrong ones, the treatment does appear to work for some people, says Hammerschlag. “We certainly don’t know enough yet to throw it out.”
—Edyta Zielinska


 

Facts about the benefits of medical marijuana are sparse, hampered by the politics and regulatory difficulties of doing such research. 

Marijuana (Cannabis sp.) has been used as a medicine for more than 4,000 years. But in the eyes of the US federal government, cannabis is an illegal drug that has no place in the clinic. Biomedical researchers who would like to study cannabis in a medical setting are frustrated by the challenges of obtaining government clearance and funding. But some data pointing to medical benefits of smoking marijuana do exist.

In 1970, the US Congress voted to classify cannabis under Schedule I of the Controlled Substances Act. Marijuana joined heroin, LSD, and peyote on Schedule I, and according to the Act, it—along with all other Schedule I drugs—has a high potential for abuse, lacks safety, and has “no currently accepted medical use in treatment in the United States.”

Marijuana plant
Marijuana plant
JOHN W BANAGAN

Since then, 16 US states and the District of Columbia have legalized the use of medicinal cannabis for a variety of indications, from chronic pain to cancer- and HIV-related appetite and weight loss, nausea, and vomiting. But despite the recent wave of state-level legalization, and the enactment of similar laws in Canada and elsewhere around the globe, the US federal government still classifies marijuana as a Schedule I drug, a designation that makes studying the medical effects of the drug in the U.S. extremely difficult (requiring approval from the Drug Enforcement Administration in addition to the Department of Health and Human Services (HHS)). Therefore, it has been far more common (and easier) to get funding and clearance to study the negative impacts of marijuana as a substance of abuse than to investigate its positive effects as a therapeutic agent.

Nonetheless, some researchers have braved the bureaucratic obstacles to conduct a handful of randomized, placebo-controlled trials that point to benefits of smoking cannabis, though they acknowledge that smoking the plant comes with its own risks and drawbacks. A more extensive body of literature involves molecular components, extracts, or synthetic forms of marijuana, simply because studying these non-Schedule I substances is less fraught with regulatory obstacles than is studying the whole plant.

The strongest evidence of smoked marijuana’s benefit exists in patients who experience chronic pain. With funding from the University of California Center for Medicinal Cannabis Research (CMCR), researchers published studies in 2007, 2008, and 2009 that all suggested smoked cannabis possessed analgesic properties. A study published in 2007, for example, noted that HIV patients experiencing neurological pain, or neuropathy—a general name for burning pain, hypersensitivity to light touch, and other uncomfortable symptoms—experienced a dulling of that pain when they smoked a cannabis cigarette three times a day for 5 days.

Psychiatrist Igor Grant, director of the center and an HIV/AIDS researcher at the University of California, San Diego, says that patients suffering from neuropathy in particular seem to find relief in cannabis. “We don’t have terrific agents to treat it. There are agents [such as antiepileptics and antidepressants] and they are modestly effective in many people,” Grant says. “The bottom line is that [cannabis] seems to work, and the effects are comparable in strength to traditional agents.”

Other studies from the CMCR have probed new conditions the plant might be used to treat. For example, UC San Diego researchers reported in 2008 that smoked marijuana has the potential to reduce muscle spasticity in multiple sclerosis (MS) patients. That finding was bolstered by a randomized, double-blind, placebo-controlled study published last year on the liquid marijuana extract Sativex, which is approved for use in some European countries, Canada, and New Zealand. The results of that trial, conducted by European researchers, indicated that a 4-week course of Sativex, an oral spray that contains the cannabinoids cannabidiol (CBD) and delta-9 tetrahydrocannabinol (THC), was safe and effective at reducing spasticity in many MS patients.

US researchers are completing Phase III trials of Sativex for the treatment of pain associated with cancer, and Otsuka Pharmaceutical, the US licensing partner of UK drugmaker GW Pharmaceuticals, hopes to gain FDA approval soon.

Aside from the relative logistical ease of studying constituents, extracts, or synthetics due to the fact that they do not run afoul of the Controlled Substances Act, these compounds stimulate the endocannabinoid system, the body’s homegrown constellation of receptors that interact with the active components of cannabis in a more tractable way than does smoked cannabis. “Harnessing that system with medications is a potentially new avenue for therapeutics,” says Mark Ware, McGill University neurologist and pain physician.

For example, Marinol is a synthetic THC drug that is used by chemotherapy patients experiencing nausea and vomiting or AIDS patients who are rapidly losing weight. It is the only FDA-approved synthetic cannabinoid, and offers an alternative to conventional therapies for these patients, though results have been mixed when comparing its effects to those of smoked cannabis, with the herbal version usually outperforming the synthetic.

This highlights one problem with going the synthetic route in the eyes of some cannabis researchers. “We shouldn’t forget that the herbal product contains multiple other constituents which may add to the effects of any one single agent,” says Ware. Also problematic are isolated cannabinoids’ tendency to be rapidly broken down in the liver and the difficulty in determining optimal doses.

As the political and social storm around medical cannabis continues to brew, most researchers who have seriously tested the drug’s therapeutic properties lament their inability to freely study it in a medical context. “The [cannabis] laws date to a time when what we knew about marijuana was voodoo,” says Mayo Clinic psychiatrist Michael Bostwick. “[The drug] can’t be applied to humans and to therapeutics because the laws don’t permit it to be done. The whole attitude towards medical marijuana is just irrational.”

For its part, the NIH claims that studying smoked marijuana is fair game. “Research projects seeking to determine the therapeutic potential of smoked marijuana are considered under the same criteria as any other project submitted for NIH funding,” the agency wrote in an e-mail to The Scientist. “Investigator-initiated applications for NIH funding are evaluated by peer-review groups composed of scientists from outside the NIH. The peer-review group evaluates the scientific and technical merit of the proposed research.” That said, the NIH’s Research Portfolio online Reporting Tools (RePORT) database lists many more active projects focusing on molecular components of cannabis or marijuana as a harmful drug than it does projects seeking to probe the potential medical benefits of smoking cannabis. Still, officials at the HHS also claim that the US government is game to fund studies of medical marijuana. “We’re very open to people submitting applications and trying to make [evaluating medical marijuana study proposals] a transparent and efficient process,” says Sarah Wattenberg, senior advisor for substance abuse policy at HHS. “In order for us to move this forward at all, we have to take the politics and stigma away, deal with it as a therapeutic class, and give people what science there is,” says Ware.

Particularly vexing to Ware is that so many people all over the world are using marijuana either recreationally or for the treatment of some ailment, legally or more often illegally, while science is forced to sit idly by and miss out on all that potential data. “We have so many people who are already doing the drug in one form or another in some sort of legal framework, but they’re not being involved in any type of research,” he says. “There’s kind of a huge natural experiment going on right now, and we’re not learning from it.”
—Bob Grant


 

While research on LSD and other hallucinogenic drugs slowed dramatically after their illegalization in the 1960s, the little research that continued has touted their promise in treating a wide range of disorders. 

In the late 1940s, researchers began experimenting with the controlled use of psychedelic drugs, such as lysergic acid diethylamide (LSD), as possible therapeutics to supplement psychotherapy. The drugs’ psycholytic or “mind-loosening” effects, they realized, made it easier for patients to explore repressed memories. Over the next few decades, research on psychedelics expanded to include their potential application to anxiety disorders, obsessive-compulsive tendencies, depression, drug and alcohol dependence, pain, bereavement reactions, sexual dysfunction, and more. By 1965, more than 2,000 published articles—most of them, admittedly, anecdotal case reports—touted the effectiveness of psychedelic drugs in helping to safely treat some 40,000 patients, with few negative side effects reported.

But rampant, uncontrolled recreational use and reports of adverse reactions during the 1960s led to the illegalization of LSD and other such drugs in the United States—cutting off the supply to research labs around the country and slowing psychedelics research to a trickle. Like marijuana, the drugs are now listed as Schedule I drugs, and researchers hoping to study their medical benefits must get approval from several different agencies and boards. In the last 10 years or so, however, new research on their therapeutic benefits has warranted the drugs’ entry into clinical studies, and today, a handful of trials are bringing psychedelics closer to use in the clinic.

LSD caps
LSD caps
RAPDEYE

“Psychedelic drugs, from a scientific viewpoint, shouldn’t even be a controversial subject,” says Ben Sessa, a child and adolescent psychiatrist working in South West England. “They are effective and safe treatments for mental illness, and there’s very good evidence for that.”

Psychedelics act on various neuro-transmitter and hormone systems in the brain. LSD and psilocybin, the psychedelic component of “magic” mushrooms, for example, affect serotonin and dopamine signaling, while MDMA, or “ecstasy,” increases output of oxytocin, among other changes. Although these neural pathways are known to regulate mood, learning and memory, bonding, and more, and their dysregulation is implicated in psychosis, exactly how the drugs’ actions in the brain translate into a therapeutic effect (or a bad trip) is still unclear. “We know what receptors they’re targeting, we know basically what kind of second messenger signals inside the cells they get started, but beyond that we don’t know how they work,” says Emmanuelle Schindler, a physician scientist and neurology resident at Yale School of Medicine. Of course, “that is not known for any psychiatric drug,” adds South Carolina–based psychiatrist and researcher Michael Mithoefer.

Uncertainties aside, several psychedelic drugs have started to show real promise in recent clinical trials. In 2010, a phase II trial of MDMA conducted by Mithoefer and colleagues successfully “cured” 10 of 12 posttraumatic stress disorder (PTSD) patients—who no longer exhibited symptoms typical of the disorder after participating in just two 8-hour psychotherapy sessions while on MDMA. The three subjects who had had to leave their jobs as a result of their PTSD were all able to return to work.

Another treatment advancing through clinical trials is the use of LSD and psilocybin to manage anxiety in patients with terminal illness. Just last year, advanced-stage cancer patients participating in a Phase II study of psilocybin responded positively after a single treatment. “We found fairly strong and consistent evidence that it did reduce anxiety and also improve mood, not simply for the hours and day of that experience but even in the weeks and months that followed,” says Charles Grob, a professor of psychiatry at the University of California, Los Angeles.

Because therapy with psychedelics involves only one or a handful of treatments over several weeks or months, there is little risk of side effects or dependence. “You just have to take them once or twice, and they can cause long-lasting changes that we don’t really see with other types of medication,” says Schindler.

However, the fact that so few doses are necessary makes it hard to find funding, notes Mithoefer. “That’s not a very profitable business model,” he says, particularly for pharmaceutical companies looking to cash in on future drug sales. Currently, researchers rely heavily on foundations such as the Multidisciplinary Association for Psychedelic Studies (MAPS) and the Heffter Research Institute, as well as a hodgepodge of other sources, to fund their work.

The illicit drugs’ unsavory history and continued recreational use also complicate the funding and clearance processes. “We have to jump through a lot of hoops . . . [to ensure that] our studies are fully sanctioned and approved,” says Grob.

Despite the hurdles, psychedelics researchers are hopeful that the next decade will see some of these therapies gain FDA approval—at least for use in patients who are not responding to traditional therapies. “What I’m seeing in the last couple of years is a real shift away from prejudice to actual interest and healthy skepticism,” says Mithoefer. “Certainly there are some detractors still out there, but for the most part it’s turned into more of a real scientific discussion.”
—Jef Akst


 

Natural doesn’t always mean safe: the scary consequences of taking understudied herbal supplements.

In the early 1990s, dozens of women, most under the age of 50, were being admitted to hospitals in Belgium with renal failure. About half of the women who had surgery to remove their nonfunctioning kidneys also had tumors in the upper urinary tract. The cases clustered around a medical clinic that had been prescribing Chinese herbs, which for more than 15 years had appeared to safely help women lose weight.

It turned out that aristolochic acid, a nephrotoxic chemical derived from Aristolochia vines, had mistakenly made it into in the slimming pill’s mix of ingredients. And while the Belgian tragedy was considered an accident, people around the world have taken the herb intentionally to aid wound healing, soothe arthritis, expel the placenta after childbirth, and repel snakes. “Every culture in the world has used Aristolochia in their traditional medicines,” says Arthur Grollman, a professor at Stony Brook University School of Medicine. “Don’t they know this is one of the most potent carcinogens that’s ever been recorded, and it’s renotoxic?”

Aristolichia debilis
Aristolichia debilis
FLICKR, TOMMYHAGA

In Taiwan, for example, one study found that one out of three people had received a prescription that included Aristolochia before the country banned the herb, and that prescriptions continued even after the ban. Interestingly, Taiwan also has one of the highest rates of upper urinary tract cancers in the world. Grollman and colleagues recently decided to test whether this coincidence has any backing in biology,  and found that of 151 Taiwanese patients with upper urinary tract cancer, 83 percent had taken Aristolochia (PNAS, 109: 8241-46, 2012). The evidence was right there in the tissue: aristolochic acid metabolites actually bound to DNA in the kidneys, and were associated with specific mutations in the p53 tumor suppressor gene.

Despite the dangers uncovered by Grollman and others, such complementary and alternative therapies, referred to now as integrative medicine, aren’t regulated as drugs in the United States. “There are thousands and thousands of products being sold through all different kinds of channels,” says Stephen Bent, a professor at the University of California, San Francisco.  ”And there isn’t the safety framework to capture and monitor how often people are having side effects or problems.”

In August of last year, Ranit Mishori, a family physician at Georgetown University School of Medicine, published case reports of two patients who ended up hospitalized after a seemingly innocuous colon cleanse (Journal of Family Practice, 60: 454-57, 2011). Sometimes taken orally, sometimes given enema-style, colon cleanses are intended to flush the system, but they can also cause a “tremendous amount of harm,” Mishori says. In one case, a patient was left severely dehydrated and with pancreatitis and an inflamed colon. In another case, a woman’s Crohn’s disease flared up shortly after a cleanse, causing days of cramping, diarrhea, and dehydration. “Since the publication of this article, I’ve heard about a lot more cases that haven’t made it into the medical literature,” Mishori adds.

Other herbal medicines that have been implicated in causing health problems include St. John’s wort, whose leaves and yellow flowers are used to treat depression, but can interfere with HIV medications; the roots of the kava-kava plant, the improper preparation of which has been linked with liver damage; and ephedra, a short evergreen bush that goes by the name ma huang, and has been tied to high blood pressure and heart attacks.

The Dietary Supplement Health and Education Act requires that manufacturers follow quality-assurance guidelines and report adverse events. But Grollman says it does not protect consumers as well as the US Food and Drug Administration’s regulations for drugs. “If herb A is such a potent carcinogen and neophrotoxin, how do you know that herbs B, C, and D are not? They’ve never been tested. . . . Natural is definitely not safe,” says Grollman. At least, as his work shows, not always.
—Kerry Grens


 

As demand for traditional medicines booms, conservationists worry about the toll it takes on the animals and plants that serve as ingredients.

Traditional folk remedies and the modern alternative medicines that harken back to such treatments rake in annual revenues of $80 billion to $200 billion worldwide. The market for such products is expected to grow exponentially in the coming years, and this has conservationists worried about unsustainable hunting and gathering of the world’s fauna and flora for medicinal uses.

The past decade has witnessed the extinction of several high-profile species hunted, in part, for their use in traditional medicines. Late last year, the International Union for Conservation of Nature (IUCN) officially declared the western black rhinoceros (Diceros bicornis longipes) of central-west Africa to be extinct due to widespread poaching and listed the northern white rhinoceros (Ceratotherium simum cottoni) as “possibly extinct in the wild.” Both species were hunted mercilessly for their horns, which have been highly valued in East Asian medicine for more than a millennium, and can sometimes approach the price of gold.

White rhino
White rhino
PETER E. LEE, FLICKR

The use of wild fauna and flora in traditional Chinese medicine (TCM), in particular, is a concern for worldwide wildlife conservation efforts. TCM is practiced by more than a quarter of the world’s population and represents a $60 billion global market. More than 10,000 plants and animals, including endangered species such as rhinos, saiga antelopes, musk deer, Asiatic Black bears, Yangtze River dolphins, pangolins, turtles, and certain species of monkeys, orchids, and sea horses, are used in TCM.

Despite the implementation of policies banning the international trade of endangered wildlife species such as tigers and rhinos in the 1980s and ‘90s, poaching and illegal trafficking of both species has seen a dramatic rise in the last decade, largely due to increasing demand from the burgeoning economies of Southeast and East Asia.

But the problem extends beyond Asia. “When rural communities were harvesting medicinal animals for their own uses, overexploitation was seldom a problem,” explains Rômulo R.N. Alves, an expert in animal-based Latin American remedies at the Universidade Estadual da Paraíba in Brazil. “However, the growing market demands and the promise of quick returns have encouraged hunters to concentrate on species with higher economic value.”

The problem is compounded by the fact that ingredients for traditional medicines are almost always collected from the wild and seldom farmed. “The medicinal fauna in Latin America is largely based on wild animals, including many endangered species,” Alves says. And it’s not just animals. In the United States, overharvesting of American ginseng (Panax quinquefolius), which has been found to lower blood-sugar levels, boost the immune system, and have anticancer properties, have rendered it endangered in the wild.

Monitoring illegally traded natural products destined for the traditional medicine market is also notoriously hard due to lack of regulation, poor quality control, and often-nonexistent labeling. Yet there is hope that by employing sophisticated technologies, such as next-generation sequencing and genetic barcoding, customs agents will be better able to confiscate traditional medicines that incorporate illegal ingredients, says Mike Bunce, a geneticist at Murdoch University in Australia who helped sequence mitochondrial and chloroplast DNA in 15 TCM products confiscated by Australian border protection officials earlier this year.

A major focus for the IUCN, the World Wildlife Fund, and other such organizations, however, has been to raise awareness among traditional medicine practitioners and patients in China about the origin of the products they use. “It’s important that users of these products take responsibility for the use and help the [bordering] countries concerned to effectively conserve these species,” says David Morgan, Chief of Scientific Support in the secretariat of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES).
—Cristina Luiggi

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Avatar of: bsardi

bsardi

Posts: 7

July 5, 2012

Are small molecules like curcumin and resveratrol considered alternative medicine? They activate more genes than any conventional medicines and exhibit safer and more effective biological action compared to many drugs.  Resveratrol inhibits cancer at all three stages of development: initiation, growth and spread (metastasis), something no cancer drug has demonstrated.  Resveratrol is an antidepressant, anti-cholesterol, anti-bacterial, anti-viral, anti-fungal, anti-brain plaque, anti-inflammatory molecule.  Why isn't resveratrol primary and the drugs secondary medicine?

Avatar of: stress124

stress124

Posts: 2

July 5, 2012

Why is no mention made of electromedical approaches that are much safer and in many cases more effective than drugs, particularly for certain types of cancer. Similarly, cranial electrotherapy stimulation is FDA cleared for treating insomnia, depression and other stress related complaints and has a 30 year record of safety and efficacy supported by numerous articles in peer-reviewed journals.

Avatar of: gmlarkin

gmlarkin

Posts: 1

July 5, 2012

Although I am not a huge proponent of herbal dietary supplements/medications, I find the above story to be exceedingly biased and unbalanced. While it is true that there are sometimes dangerous consequences to using these therapies, how do they differ from the litany of side effects that accompany the use of pharmaceuticals (approved by FDA)? Also what about the long history of botanicals that have been exploited into single compound drugs? For example Salix spp. that provided aspirin, valerian that yielded valium, foxglove that gave us digitalis? The list goes on. I suggest that fair reporting would be of great benefit to your reputation and to your readership. Oh I forgot your bills are paid by BIG PHARMA. 

Avatar of: gabrik56

gabrik56

Posts: 2

July 5, 2012

Surprisingly this very interesting article does not mention at all homeopathy: Is this medicine alternative or official? In the first case it should have been thoroughly discussed, in the second case -what I’m deeply afraid-, anyone can understand the huge financial and maybe political interests that revolve around " this fine invention". Personally I trust much more in the laying on of hands -pranotherapy- (which should have been mentioned and discussed too) than in homeopathy

Avatar of: E Elaine Connelly

E Elaine Connelly

Posts: 1457

July 5, 2012

I have been  told by my family physician that I have high Cholesterol.  The very 1st testing I underwent showed my good cholesterol to be @ 71, after taking a regimen of statins (all of which gave me severe muscle pain) my next test showed extremely lowered HDL.  I cannot take statins, I refuse to.  I am not obese, so I am taking red yeast rice (2000 mg) a day, my next test is July 9.  I am anxious to find out if that is doing the trick.  I also take cinnamon to lower blood sugar levels as they also found out that I was pre-diabetic.  Again, I believe both of these conditions are genetically related.  I try to eat well, to not pig out on sugar loaded foods, and as little processed food as I can manage.  I have done research on my own about a little gland called parathyroid.  When this gland is not functioning properly, I have discovered that it can mimic both conditions to which I am pre-disposed (supposedly).  Clinical trials do not apply in my case.  Guess I'll find out in 4 days whether or not I am doing okay.  I am on Actos (which has been proved to cause bladder cancer).  I really don't want to remain on more chemical drugs which cause some of the very problems I am supposed to have.  Scientists do not know everything and they are not Gods, even though they seem to think so.

Avatar of: steinp2

steinp2

Posts: 33

July 5, 2012

Scientists don't believe they are gods.  They are much too humble and altruistic.  They are the ones who did all the research on the parathyroid you are looking at and came up with all of the drugs which may or may not work on you.  They are also the ones who are working on weekends and into the night in confined laboratories at fairly low pay to try to figure out just what the hell to come up with next to help you and everyone else out there.  The Greek and Roman gods were the ones who would toy with and just as easily dismiss man at their whim.  Now, who in the readily visible healthcare system of today does that really look like?

Paul M. Stein

Avatar of: StanYoung

StanYoung

Posts: 3

July 5, 2012

Many alternative treatments have been rigorously tested. Virtually all of them failed in randomized clinical trials.

Avatar of: Jim English

Jim English

Posts: 1

July 5, 2012

When your writers do a piece on modern pharmaceuticals I hope they will be fair and take the same approach as in your section on herbs: 1. Choose to focus your article only on drugs with significant side effects; 2. Point out that FDA approved drugs are implicated in over 100,000 deaths per year in the U.S., according to the NIH; 3) Fail to include a single example of a drug that actually improves health and quality of life, and 4) End with a quote from an "expert" stating that the side effects and risks from approved pharmaceuticals are too risky to consider taking at this time.  

Avatar of: Mark Maier

Mark Maier

Posts: 1457

July 5, 2012

Many of the best drugs were discovered in plants... aspirin, digitalis, docetaxel... the list is long. It is not an hypothesis that non-traditional therapies work. They do. We need consistent dose, response and quality control so at least practitioners can reach anecdotal conclusions that can become testable hypotheses. FDA and EMEA are doing pretty well, but could put more focus on alternative therapies. It is Draconian to regulate marijuana as a controlled substance.

Avatar of: wrmcg

wrmcg

Posts: 1

July 5, 2012

In all of the article, and the comments, not a solitary mention of essential oils and specific bioactive plant fractions from essential oils! More and more health care institutions are introducing essential oil treatment systems into their treatment regimes, whereby patients are obtaining measurable benefits in perceived pain reduction, nausea, anxiety, etc. Use of simple, cheap devices such as passive inhalers allows self-administration by patients of tiny controlled amounts, thereby freeing nurses for other tasks, freeing patients from the frustration of button-pushing, and presenting a cost-effective alternative to administrators: an all-round win/win/win.  There is plenty of evidence to support the use of essential oils; just make sure the rigorous testing in randomized trials uses protocols established for evaluation of essential oils, not hydrophilic drugs.

Avatar of: steinp2

steinp2

Posts: 33

July 5, 2012

"Boost the immune system".  That term is thrown out there so much, seems "scientific", and has that "Oooooooo factor", but just what exactly does it mean in reality?

Paul M. Stein  

Avatar of: Robert Slovak

Robert Slovak

Posts: 1

July 5, 2012

The article was patently incompetent. Naive even. The authors (the Scientist Staff), if I may quote Shakespeare, are "full of sound and fury signifying nothing". Judging by the comments, your readers possess far more scientific knowledge and wisdom. Move along to other topics for which you may be qualified..."For many are called but few are chosen".

Avatar of: Ted Howard NZ

Ted Howard NZ

Posts: 7

July 5, 2012

A little over 2 years ago I was told that there was nothing known to medical science that could alter the probability of my survival.   I had metastasised melanoma, with inoperable tumours on my liver.

As a biochemist by training I decided to do my own investigation, and to try anything that seemed to have some evidence for its usefulness, and didn't cost much.

I radically altered my diet - went strict Vegan (RAVE Vegan) with supplements of Vitamin C (about 20g per day) and Mineral/Multivitamin - one capsule per day.

It took about 4 months for the tumours on my liver to shrink below resolution by ultrasound or CAT.

I have twice reduced vitamin C, and each time had new tumours show up, which I had surgically removed and identified by histology.
I haven't missed a day on Vitamin C for 16 months, and my scans before Christmas were all clear.

I seem to have beaten it, with the regime I am on.
My full details are on my blogsite - www.tedhowardnz.wordpress.com/... if anyone is interested (indluding all medical reports, and histology.

While there are many great people in the medical establishment, the profit motive seems to be a major impediment to health.

Avatar of: healthforyou

healthforyou

Posts: 1

July 5, 2012

Has anyone checked out the Science of Glycobiology? It looks like when a person takes these plant sacharrides that the body can pretty much look after itself.

Avatar of: Paul Walker

Paul Walker

Posts: 1

July 5, 2012

Whatever happened to science based pharmacology?
In the early 90's the The US Congress mandated the NIH to fund a dozen or, so alternative medicines and treatment therapies. If I remember they were all a bust.
No value what so ever when blind and statistical testing were done.

Avatar of: Hominid

Hominid

Posts: 18

July 6, 2012

There will always be the new-age delusional types who are desperate for snake oils.

Avatar of: Hominid

Hominid

Posts: 18

July 6, 2012

You claim to be a biochemist and you present your uncontrolled, under-sampled, anecdotal, personal experience as evidence in favor of an unrationalized, wholly empirical therapeutic regime?  Puh-leez! 

Avatar of: rxman123

rxman123

Posts: 2

July 6, 2012

Based on the flawed perception that herbals and naturals are
free of side effects appears to be common hope with its users. Taking both
herbs and prescription medications points to real and consistent risks of serious  life threating events.  Let’s not forget the situation with Seldane
and Grapefruit inhibiting the enzymatic conversion of a Seldane metabolite that
caused cardiac arrhythmias and several deaths. 
The information regarding serotonin enhancements with St. Johns wort if
combine with SSRI’s . we must remember that so many of the modern pharmaceuticals
had their genesis from natural products – Aspirin, Ace inhibitors, Cardiac ,
Oncology drugs.  As a society we are led
to believe that potency comes from the pharmaceutical manufacturer. 

Avatar of: John Hanes

John Hanes

Posts: 1457

July 6, 2012

What a poorly informed article! At least in Australia, our therapeutic herbal and nutritional remedies are controlled somewhat by the Therapeutic Goods Administration so we have some quality control in our professional products. But woe betide the consumer who goes for the bargain medicines available via the internet from US. The article only mentioned the far-out alternatives which, except for acupuncture, are not used by qualified natural therapists. Herbal and nutritional medicines have been studied in depth and have been shown to work. I am a naturopath and I get good results, even with the medical failures - Crohn's, colitis, IBS, chronic respiratory infections, etc. The naturopath does not apply the natural medicines using the same health model as conventional medicine does, i.e. use the herb in the same way as a drug and expect a result. The naturopath treats the person with diet (a major factor) and lifestyle modifications supported by herbal and nutritional medicine where appropriate. Probiotics are included where necessary as a support, but not expecting drug-like responses as the trials in the article did.

Perhaps the medical model of health needs changing.
John Hanes, BSc, ND   

Avatar of: David_Colquhoun

David_Colquhoun

Posts: 5

July 6, 2012

I see the quacks are piling in already.  These articles are, by and large, far too lenient on disproven and unproven "remedies".

The way in which US univerities have lined up to take cash from NCCAM and Bravewell is utterly disgraceful.  In most countries these activities are limited to a handful of univerities at the bottom of the pecking order.  In the USA, Yale, Harvard, Mayo, all have departments filled with quackademics.  See some of the nonsense they spout here http://www.youtube.com/watch?v...

I just cancelled by sub to the Scientist.

Avatar of: steinp2

steinp2

Posts: 33

July 6, 2012

You just don't know.

Avatar of: Hominid

Hominid

Posts: 18

July 6, 2012

Take an immunology course.

Avatar of: steinp2

steinp2

Posts: 33

July 6, 2012

-.

Avatar of: steinp2

steinp2

Posts: 33

July 6, 2012

Did that, got a doctorate, read a lot in the discipline every week, and attend the annual Experimental Biology meeting.  I have yet to hear a scientific explanation for the term "boost".  Perhaps your immunology course and background is better than mine, so what cells, receptors, cytokines, etc. are "boosted" by the chemicals in question?  What is significantly upregulated and what is downregulated?  What specific targets are affected?  Please enlighten us.

Avatar of: SynicInSF

SynicInSF

Posts: 2

July 6, 2012

I'm going to chime in here. One third of our pharmaceuticals are derived or copied from natural drugs. 

Avatar of: edwardwhite65

edwardwhite65

Posts: 3

July 6, 2012

 Good response, Jim.  And I'll add that there is an arrogance about 'rationally designed' drugs that pervades even so-called unbiased, scientific approaches and investigations into alternative medicines (ie. the article above).  It's a tacit 'I know better, but I'll give you a few minutes of my professional opinion.'  I recently heard a renowned colleague scorn at the idea of natural products actually working--how could they, he said, when we don't know the mechanism?  He forgot that the most successful drugs in history--analgesics and anasthetics--had for many years told us little of how they actually worked.

Avatar of: Hominid

Hominid

Posts: 18

July 6, 2012

Bingo.  When rigorous science is applied, folklore loses.

Avatar of: Hominid

Hominid

Posts: 18

July 6, 2012

Do you mean scientists or physicians - they're not at all the same thing.

Avatar of: Winston_Macchi

Winston_Macchi

Posts: 2

July 6, 2012

I hate to break it to you, but red yeast rice and cinnamon are chemicals as well.

Avatar of: Winston_Macchi

Winston_Macchi

Posts: 2

July 6, 2012

Why is that surprising?  It isn't medicine of any type, alternative or otherwise. It's in the realm of healing crystals and astrology (and pranotherapy).

Avatar of: gabrik56

gabrik56

Posts: 2

July 6, 2012

I completely agree with you, and more. My mention about pranotherapy was just ironical and sarcastic.

Avatar of: Hominid

Hominid

Posts: 18

July 6, 2012

Biased?  Unbalanced? - C'mon!  The essay is FOCUSED on the potential efficacy of alternative meds & also points out the potential problems associated with them. 

Avatar of: Hominid

Hominid

Posts: 18

July 6, 2012

The 'efficacy' is not so clear-cut as you imply.

July 7, 2012

Here is the danger of alternative
treatments:

"Patients reported feeling
better after albuterol treatment, as well as after sham acupuncture and the
placebo inhaler, but not if they received no treatment at all. However, when
researchers took an objective measure of their asthma—the maximum forced
expiratory volume in one second—it was clear that only those treated with
albuterol actually improved."

Avatar of: Don Margolis

Don Margolis

Posts: 1457

July 7, 2012

First--kudos for a fine balanced series of articles.  I disagree with a few items but I learned more than I thought I would.  
Second are the many many critical "comments," which I find especially humorous.  You have been accused of being biased both for and against alternatives and also for and against alternatives.
Third--I wish to advise serious readers of something none of your writers dared mention, and that it the super-strong control Big Business has on the FDA, on most doctors, and on ALL major media.  There simply is NO available data from any source accurately portraying the corruption in all major drug companies, lying about results, denying side effects, adding unapproved diseases, and hiding deaths by the thousands.  

Last week I pointed out a few samples of such tactics on a major blog and was soundly attacked on Sunday and Monday by two commenters saying "How dare you.  Our drug companies are doing a wonderfully honest job of saving lives."  Then, Tuesday came the news that Glaxo had just been fined 3 BILLION dollars for breaking more laws than I could count.  On Wednesday I received, unsolicited, an analysis of six other glaxo-like frauds over the past 12 moths.

Never mentioned is the fact that Big Pharma paid Congress in the 1930s and bribed their way over the AMA's recommendations and made one of the finest cancer cures illegal. Today it is legal as a pain reliever in some states.  But Pharma has such a noose around the public mindset that the one big state, California, voted 59% to make that use of marijuana illegal, even for dying cancer patients.  Laetrile falls into that category as do dozens of others. You can bet that whenever a working natural cure gains popularity, Pharma will pay a group of crooked scientists to "prove" otherwise, and that "proof" will make it into most major publications, from newspapers, to magazines, and to now-controlled major websites.

So whenever you see the word "quack" or "quackwatch," know that like every national disease society, they are controlled and funded by Pharma to keep you buying useless, toxic pills in a medical system which forbids the cure of ANY chronic disease.

Avatar of: stress124

stress124

Posts: 2

July 9, 2012

Suggest you access _http://www.alpha-stim.com/res...

for efficacy of cranial electrotherapy stimulation

See also _http://www.microwavenews.com/...

for a description of a new, more effective and much safer way to treat liver cancer.

Avatar of: tmigratorius

tmigratorius

Posts: 1457

July 11, 2012

Your issue was perfect to illustrate to my students the
negative and fear-mongering attitude towards a model of healing that the World
Health Organization respects. It was also an excellent example of the
scientific mistakes common in the literature. The photo of Aristolochia
(birthwort) is incorrect. The yellow flower (positioned upside down, by the way)
is Corydalis (probably C. aurea) in the pea family (Fabaceae), not Aristolochia
in the birthwort family (Aristolochiaceae). 
A quick check to Wikipedia would have been sufficient to signal the
mistake. I’ll let the other comments speak for the uninformed and biased
treatment of this subject.

Avatar of: Blake

Blake

Posts: 1457

July 12, 2012

A more balanced journalistic piece on 'alternative' medicine would contain some mention that fish oil is currently a FDA drug (Lovaza) approved to treat high triglyceride levels.  Vitamin B3 is also an FDA approved drug marketed as Niaspan.  

Nearly every day, randomized, placebo-controlled clinical trials are published on non-drug nutritional and natural products.  Most are indexed in Pubmed.

It is also worth noting that out of all the hysteria on drug-herb interactions, finding any original research on the 'harmful' effects of herbs is difficult.  With ~70% of people taking dietary supplements, one might think the journals would be filled to the brim with case studies documenting the scourge.Lastly, it is interesting to view FDA budget allocation in terms of their main objective: risk management.  2012 budget for Drug Safety, Premarket Review and Generics totals about  $2,900 million.  Food Safety is $1,100 million. Dietary Supplements? $19 million.*   *Source: page 548, http://www.fda.gov/downloads/A...

Avatar of: TAGarran

TAGarran

Posts: 5

July 12, 2012

Well, first, your statement suggests that science is 'always' applied rigorously when it comes to drugs...News Flash! It isn't!

And second, your use of the term 'folklore' suggests that billions of people today are swayed by some ancient belief system into a state of health after consuming plants as medicine. Now that is some real fantasy there. Perhaps you should do your research, actual 'scientific research' before making a fool of yourself in public.

Mr. Young, could you provide us with a source for your statement? I would love to see from where it comes...oh, right, there is no such source...

Avatar of: TAGarran

TAGarran

Posts: 5

July 12, 2012

 Actually, they are myriad chemicals, not single molecule like drugs, very different. But you knew that already. And, red rice yeast is basically a statin, not particularly safe, but pretty darn effective if you take enough.

Avatar of: TAGarran

TAGarran

Posts: 5

July 12, 2012

 But never mentions any benefits, or even potential benefits....thus it is biased. Pretty simple really.

Avatar of: TAGarran

TAGarran

Posts: 5

July 12, 2012

 News flash! All therapies are empirical! Regardless of what you may think, this is, and has always been the basis of science. Thus, I think this might work. I try it, it works. I try it again, and it works. Generations later we have a system. If it doesn't work, I discard it in favor or something that does work. Basic human nature.

Avatar of: TAGarran

TAGarran

Posts: 5

July 12, 2012

BTW: The Scientist, if you are going to write an article, you might want to put the correct heading with your photographs....just a thought.

July 15, 2012

The herbal article is written poorly, with dated material, reiterating old information - pretty much as if writing about thalidomide when discussing modern drugs.

About 100 people die every year of herbs - and mostly because psychedelic mushrooms and other mushrooms have been abused. About 100.000 patients die every year of prescription drugs and regulated over-the-counter drugs. If in a herbal article those 100.000 deaths are not mentioned, I call it "biased reporting".

The Scientist can do better in providing objective information instead of fear-mongering about herbs. We have ancient bodies, with an ancient physiology, and herbs fit that physiology like a key in its lock.

Alexa Fleckenstein M.D., physician, author.

Avatar of: Hominid

Hominid

Posts: 18

July 15, 2012

Sorry, TA, - it's not at all the 'basis of science.'

For a field of investigation to be considered scientifically rigorous it must express reproducibly testable hypotheses that make unambiguous, preferably quantifiable predictions under carefully controlled experimental conditions.  While they may be of social interest and (or) inspire rigorous hypotheses, phenomena, correlative studies, studies that depend on subjective responses, and studies where variables are not controlled are not sufficiently empirical to be considered rigorous science.

Avatar of: Ted Howard NZ

Ted Howard NZ

Posts: 7

July 15, 2012

In my case, I had only a sample of one.
Four times I reduced Vit C, and had tumours show up.
Twice I had those tumours removed surgically and identified by Histology, twice I simply increased dose again and had them disappear.

It is not a fully randomised study, and with what I had available, it is the best I could do.

The so called "randomised studies" that I have seen have been full of "holes" and bisases.

I simply put my own dataset out there for others to use as they see fit.

The medical establishment told me to get my affairs in order, as there was nothing they could do for me.
Officially I am still a "terminal cancer patient" in "spontaneous remission".   Personally - I think the terminology is atrocious, and the medical system is much more about making profits than it is about human health - despite there being many great individuals within the system.

Avatar of: Ted Howard NZ

Ted Howard NZ

Posts: 7

July 15, 2012

Hominid,

Consider another perspective.

I did not do this for any reason to convince anyone of anything.
I went to see a doctor, then had to go home and tell my wife and daughter that I was not expected to live until Christmas.

That wasn't an easy situation for any of us.

I looked for anything that seemed to have some evidence supporting it, that didn't cost a lot of money (I didn't have much money, and I didn't want to use all of what little we had if it was likely to leave my wife and child destitute if it failed).

I did not start this process with any interest in proving anything, one way or another.

All I wanted to do was to be able to live, to be there for my family.

Everything else is simply a side benefit.
I share it, for what it is worth.
I ask no money.
I ask no favours.
I simply offer my experience, in the hope that it may help others.

I would not not wish that experience on my worst enemy.

Avatar of: CuriousPhD

CuriousPhD

Posts: 1

July 26, 2012

I looked at your sections on costs, thinking that it meant something different.  Has anyone looked in to the cost-effectiveness of alternative medicines?  For example, these therapies might provide some relief for people who live in remote regions, far away from western hospitals.  Could these remedies be used as more affordable means of therapy for chronic conditions? Could they be used by people who can't afford pills?

Avatar of: Gordon Kelley

Gordon Kelley

Posts: 1457

July 30, 2012

What's your source for people dying due to abuse of magic mushrooms? That's rank speculation, in my experience. If you are conflating psilocybin with other, more dangerous, drugs, please check yourself.
The LD50 for psilocybin is as follows:

285 mg/kg i.v.(mice)

280 mg/kg i.v. (rats)

12.8 mg/kg i.v. (rabbits)

All of these dosages are intravenous meaning into the vein.
To reach these concentrations orally, without vomiting, would take an extreme
amount of diligence.

Looking at the scale of comparitive potency and assuming
that .6% of an average cubensis mushroom is active (6 milligrams), and that a
strong to heavy dose of psilcybin/cin is 20mg, we see that it would take a
monumental dose(several pounds of dried mushrooms) to accidently overdose.

I did a brief google search and found ONE instance of someone dying due to overconsumption of psilocybin. These are psychological tools with vast potential, and I encourage you to not slander their use offhand.

Otherwise, I totally agree with you.

Avatar of: EllenHunt

EllenHunt

Posts: 74

July 31, 2012

While you are mostly correct, there are four significant concerns with mushrooms.

First is incorrect identification of mushrooms leading to illness or mortality. The most common confusion is with certain amanita species, some of which also have hallucinogenic properties. Second is difference in dose, since the average you cite has wide variance, with mushrooms measured as high as 2% psilocybin. Third is toxic components of certain varieties of psilocybe and these can also vary significantly. The final concern is use by susceptible individuals, particularly young teens and children. There are clear cases of induced psychosis in teens leading to prolonged (probably lifetime) incarceration from intensive use of psychedelics with psilocybin being part of that mix.

Avatar of: agelbert

agelbert

Posts: 50

July 31, 2012

I applaud this article for pointing out that important reality about the 4,000 years of Cannabis use.
As to dangers of psychoactive substances in nature, I wish to remind our scientific community of a U.S. government study nearly 12 years old now that found that an average 106,000 people die each year from pharmaceutical related adverse side effects. the actual suicides in this group are statistically insignificant. These deaths are from prescribed medications at therapeutic doses. With this kind of track record, one that the use and abuse of natural substances does not now or ever had, it is a tad ridiculous to voice concerns about all the poisons in nature such as alkaloids in many plants. Mankind did quite well prior to the scientific method in recognizing dangerous substances and passing that information about what to eat (and how much of it was toxic) for nutrition and/or disease prevention onto subsequent keepers of that knowledge among the various cultures. The fact that they didn't perform FDA double blind tests on mammalian models in a statistically significant group only invalidates this wisdom when a scientist becomes opinionated and disdainful about the critical thinking skills of his ancestors. I say it's time for a little more humility and a little less arrogance. The reason worldwide deaths are low from natural substances is because nature doesn't concentrate her chemicals like the pharmaceutical industry does. Any serious scientist knows this. Furthermore, like the current view that acupuncture is a placebo (conveniently disparaging thousands of years of Chinese intelligence, critical thinking and empirical observations), the fact that we cannot measure biochemical cause and effect does not mean that there is no biochemical cause and effect. The fault, as has happened previously in other areas of medical science (e.g. the ridiculous view of heart function prior to the understanding of electricity's role in a natural pacemaker), is probably in our instrumentation. The blind faith is more on the side of empiricists that claim something isn't there because they can't measure it. Pasteur and Lister encountered EXACTLY the same kind of arrogant dismissals and bigoted behavior. It's time for the government to stop dictating what natural substances people put in their bodies. If, or when, the associated deaths of users exceeds prescribed medication deaths or targeted species predation from some real or imagined substance people are using threatens extinction, then science should sound the alarm. Until then, science should be screaming from the rooftops that, statistically, you are more likely to die from prescribed medication than an overdose of foxglove leaves.
 http://www.naturalnews.com/036...

Avatar of: GPINK

GPINK

Posts: 1

July 31, 2012

It would be good to place psychodelics under the microscope of science.  It would not be good to make them publicly available as was done illegally and dangerously in the 1960's.  I lived through that self-centered era and have lived with one of its victims for over 40 years.  I am all for the dissection of active components of cannabis, nicotine and so forth, but am against their being made available in their raw form.  My reasoning is simple.  True, for thousands of years they have been used by medicine men in their attempts to cure diseases of every sort.  A great saint of the Catholic Church, Martin de Porres was known for his miraculous powers and his use of herbs to cure diseases.  However, we have the best, most intelligent approach to medicine ever in our day ever in all of human history.  We know that there are hundreds of active substances in herbs and each one of these has a particular use while tendering at the same time unwanted side effects.  The random application of a natural herb puts that individual at risk from the side effects of a plethora of substances as well as most being unnecessary for the treatment of disease.  From a medical viewpoint, cannabis can induce schizoid disorders including schizophrenia.  These are progressive disorders and their progression can be accelerated because of the effect they have on certain brain neurons associated with creativity.  The pain reducing effect of cannabis is at best weak and there are other much better and safer drugs available for pain.  By the way, if increasing creativity is desired, read a book and spend some time thinking intelligently.  That will increase one's creative intellect immensely.  As adept as he was at curing illness, I do not think Martin De Porres would agree with tehwidespread indiscriminate use of herbs and would prefer modern pharmacy over his concoctions.  It scares me to read comments by admitted users of particularly cannabis.  Their thoughts are usually disordered and angry and tunnel visioned.  Let's find an intelligent solution to pharmacy, not personal diagnosis and treatment.  I wish deeply that even tobacco would come under the yoke of medical use.  Because of its widespread use and secondary exposure effects, it's pharmaceutical use is extremely limited and that can be extremely dangerous even deadly in some circumstances.  My final word, it is shameful the massive greed of drug companies who by their greed stand in the way of cures of diseases.  There is no reason why treatment of AIDS should be as expensive as it is.  Embryonic stem cell research because it always introduces foreign substance into an individual will always cost 10-20 thousand dollars a year to treat for anti rejection placing people under the yoke of slavery to greed.  Focus here has no promise for a cure, only replacing one pathology with another that is very lucrative to the money mongers.  Money should be spent on the use of what is in the person to cure disease in the person because it has the highest promise and least expense.  Treatment of psychiatric disorders can be ungodly expensive.  I beg all who have my concern to approach the need intelligently.

Avatar of: agelbert

agelbert

Posts: 50

July 31, 2012

I applaud this article for pointing out that important reality about the 4,000 years of Cannabis use.
As to dangers of psychoactive substances in nature, I wish to remind our scientific community of a U.S. government study nearly 12 years old now that found that an average 106,000 people die each year from pharmaceutical related adverse side effects. the actual suicides in this group are statistically insignificant. These deaths are from prescribed medications at therapeutic doses. With this kind of track record, one that the use and abuse of natural substances does not now or ever had, it is a tad ridiculous to voice concerns about all the poisons in nature such as alkaloids in many plants. Mankind did quite well prior to the scientific method in recognizing dangerous substances and passing that information about what to eat (and how much of it was toxic) for nutrition and/or disease prevention onto subsequent keepers of that knowledge among the various cultures. The fact that they didn't perform FDA double blind tests on mammalian models in a statistically significant group only invalidates this wisdom when a scientist becomes opinionated and disdainful about the critical thinking skills of his ancestors. I say it's time for a little more humility and a little less arrogance. The reason worldwide deaths are low from natural substances is because nature doesn't concentrate her poisons like the pharmaceutical does. Any serious scientist knows this. Furthermore, like the current view that acupuncture is a placebo (conveniently disparaging thousands of years of Chinese intelligence, critical thinking and empirical observations), the fact that we cannot measure biochemical cause and effect does not mean that there is no biochemical cause and effect. The fault, as has happened previously in other areas of medical science (e.g. the ridiculous view of heart function prior to the understanding of electricity's role in a natural pacemaker), is probably in our instrumentation. The blind faith is more on the side of empiricists that claim something isn't there because they can't measure it. Pasteur and Lister encountered EXACTLY the same kind of arrogant dismissals and bigoted behavior. It's time for the government to stop dictating what natural substances people put in their bodies. If, or when, the associated deaths of users exceeds prescribed medication deaths or targeted species predation from some real or imagined substance people are using threatens extinction. then science should sound the alarm. Until then, science should be screaming from the rooftops that statistically you are more likely to die from prescribed medication than an overdose of foxglove leaves.

Avatar of: agelbert

agelbert

Posts: 50

July 31, 2012

Yep. And when the "active" ingredients were synthesized and patented, bad things started happening.

http://www.naturalnews.com/036...

Avatar of: agelbert

agelbert

Posts: 50

July 31, 2012

Remember the comments are moderated. It's called censorship.

Avatar of: FJScientist

FJScientist

Posts: 52

August 2, 2012

I think you may be experiencing a knee-jerk defense to a perceived attack on something you hold dear. The author of the article prominently indicated that many, if not most, rigorously tested and approved drugs have natural origins. The key question is which of the natural products have the benefits claimed, which may be neutral and, perhaps mostly importantly, which are harmful. That is the purpose of the trials which, as you point out, even have been done for some traditional remedies. However, we should not loose sight of the findings that a large number of over-the-counter natural products have failed to show benefits when rigorously tested. We should also not assume that all will fail. We simply don't know which are effective in the absence of tests using a large enough sample to be reasonably confident of the findings in relationship to statistical error.

BTW, the FDA (and similar agencies elsewhere) approves pharmaceuticals for specific indications based on clinical trials that establish their safety and efficacy for that indication only. Subsequently many are used by physicians for other indications or diseases. In a way, that 'off-label' prescription is similar to the free-for-all, word-of-mouth, not rigorously tested approach of most natural remedies. However, the FDA prohibits the pharmaceutical companies from advertising or indicating to physicians those off-label purported uses. There are mechanisms for physicians to report what they consider to be unusual adverse effects of both on-label and off-label uses of the drugs. If enough adverse effects are reported, they are investigated. Thus, off-label and even approved drug uses are monitored after the fact.  

So, there are rumored uses for both natural remedies and off-label pharmaceuticals. But that does not abrogate the need for knowledge about safety and efficacy for those uses. The author of the piece is merely cautioning that many trials have not been done. Side effects and drug-drug interactions still can be there even if the product is 'natural' or approved. Those side effects may only become apparent after use on large numbers of patients. So it is important for the patient to be properly educated about the known and unknown effects of a purported remedy regardless of that remedy's origins. If the data isn't available, it is important for the patient to know that it is not.

Frankly, there are not enough human subjects available to conduct all of those trials. A thousand years of using a natural product may be good enough for some patients. But I also know that certain illnesses and certain heath benefits track with certain populations, possibly because of genetics and possibly because of environment, which includes the products they consume be it for nourishment or for perceived medicinal value. I, as a patient, need to evaluate what is known, what is not known, and make an educated guess about what product I wish to use. If a product has been tested rigorously and shown to be effective, that is what I personally would choose. Otherwise, I most likely am wasting my time which, in a particularly acute treatment scenario, could be the difference between life and death.

Avatar of: Moosecrackers

Moosecrackers

Posts: 1

August 19, 2012

Too bad ... had just discovered this site and thought it looked promising, until I ran across this article. Quite the U.S. exceptionalism displayed here ... the Chinese (et al.) have been utterly stupid for 3,000 years, and we can prove it with one or two reductionist 'studies,' which, because we're so much more intelligent, negate thousands of years of practical experience and day-to-day science.

Ignorance joined at the hip with arrogance is really not very attractive, or helpful.

Avatar of: Sierra Hennessy

Sierra Hennessy

Posts: 1457

September 17, 2012

This is a sorry article. The entire rest of the world utilizes this so called "quackery" and manages to get along much healthier and happier than the USA. The majority of trials in the US are done or in part financed by Big Pharma, who have a vested interest in Americans hooked on their drugs and the our disgusting health system that treats the disease without supporting any preventative treatment. The idea that a person could get well just by educating themselves on how to use what grows out of the ground for free is anathema to these corporations. I'm not saying they all work, and when it comes to major illnesses such as cancer, its always best to see a professional. But if this so called quackery can PREVENT cancer in the first place, don't our drs. have the moral responsibility to educate themselves and find out, even if it means less patients and less money?

Avatar of: Lynn Keller

Lynn Keller

Posts: 1457

September 17, 2012

The humanistic response to reported experience is, "We cant yet explain why you feel better with this therapy."
Science is in infancy revealing the reasons for things not seen but felt. The principle of biochemical individuality means the language and gold standard of western medicine will not work as a measurement in the study of cultural therapies that nevertheless offer a vast world of helpful treatment and healing.
I was told decades ago to take geriatric patients of
f B12 injections because they were according to research "only placebo response". But they felt better. Do you trust people's experience clinically or go with what is on paper?
Just in the last few years it has been revealed that the methyl donation from the B12 (methylcobalamin) is an antioxidant for the CNS and virtually upregulates every neurotransmitter cycle in the brain. The hottest ticket in psychopharmacology right now is 5MTHF (methyltetrahydrafolate) a fraction of B vitamins and active methyl donor.

Pharmaceutical companies are the only ones with the money to do glossy studies and advertise to doctors. Bioidentical, nutrient and energy therapies cannot be patented and sold as profit (although pharmaceutical companies are repackaging 5MTHF and selling it at huge markup). So the evidence demanded by mainstream academic science will not be rapidly arriving. And those of us in the field, as historically has been true, really don't care.

Avatar of: Indi Newall

Indi Newall

Posts: 1

September 17, 2012

I'm puzzled by the absolute dismissal of anecdotal evidence as valid in a discussion that relates directly to the experience, ie suffering or not, of individual persons. What could be more valid in such a discussion? It seems that those decrying anecdotal evidence and demanding we stick merely to large, double-blind tests, have an existing bias towards conventional, and away from 'traditional' medicines. The experiences of one person in significantly improving their cancer prognosis, or relieving themselves of debilitating psychological afflictions through non-conventional treatments, are far more valid to the person in question than any number of clinical studies. When discussing medicine, treatment of illness and particularly the pain or other experiential consequences of disease, what could be more important to the individual than the relief of their own symptoms? My beef in particular concerns marijuana and psychedelic drugs which are listed in the same category as drugs like crystal meth, which are made from stuff you find in the laundry sink, prepared by people who like motorbikes. Anyone who has worked, effectively, with psychedelics, i.e. not as a replacement for flicking on the TV, but as an actual incisive tool towards psychological health and self-discovery, will tell you that there is one reason and one reason only that the governments of the world don't want you going near psychedelics - because they know what you are going to see, and that it will make you harder to control as a mindless drone. I have close friends who left the army after one dose of psilocybin mushrooms, and found themselves unable to kill another human in light of the obviousness that the appearance of separateness is far more illusory than we are led to believe. The incidence of psychosis related to the use of these compounds was greatly exaggerated during the period of heavy regulation which followed the summer of love, and why? What was really going on which needed to be controlled? People were speaking out against war, preaching love and tolerance, and it threatened to undermine the hawkish war profiteering which had become accepted as the par for the course in the American mindset. It is good to see that at last the witch-hunt mentality which has shadowed these most remarkable of compounds for a generation, is at last being replaced by the healthy, open-minded skepticism which should be the hallmark of any enlightened society.

September 18, 2012

I am skeptical of many claims made by alternative therapies but when they do have real health benefits even if it just the placebo effect or work by some unknown mechanism I think they should not be so dismissed. It does need better regulation and understanding of the mechanism of how it works as unfortunately there are a lot of unethical people out who are exploiting sick people under the guise of alternative medicine. Which is why in Asia it is increasingly coming under the umbrella of the hospitals and Orthodox Medical clinics.

I hate how may supporters of alternative therapy dismiss cinical trials and studies which are important so that we can try and understand it better and give us better guidelines to reduce negative effects. We should not disregard the evidence produced by these but seeks ways to expand it - after all how much money and resources goes into drug development. We can't just rely on anectodal accounts. Those types of trials and studies gave us understanding in how to treat illnesses and eiminated unsuitable drugs with dangerous side effects too.

I also hate the phrase ALTERNATIVE when people are talking about TCM. I grew up with it and people misunderstand it. Like you are going to not use conventional medicine when you are ill and opt for one of these. What people fail to realise here with TCM is it should not be sort when they are ill and abandoned when they are better or as an alternative to orthodox medicine.

It is often used in conjunction with mainstream medicine and is only one element of an overall approach to being healthy. For example in Hong Kong, in many hospitals the TCM departments makes referrals to all the mainstream departments and vice a versa. Something like accupuncture is often used with herbs, massage, exercise, changes in the diet & mainstream drugs/therapies. It is probably the mainstream medicine that is elminating the symptoms but the rest of it promotes general well-being/health that can aid recovery and be a constant reminder to take better care of your body/health (be proactive and prevent illness). After all if you can be bothered to spend time and money to cook and drink some of those god awful herbs regularly, see an accupuncturist or massage people, then you can certainly be motivated enough to do some exercise, eat well and relax for your own health too.


Avatar of: Ben Wiseman

Ben Wiseman

Posts: 1457

September 18, 2012

Because arguments from antiquity are valid. Stupid hippy.

Avatar of: sb708

sb708

Posts: 2

September 18, 2012

and yet you might wonder why religious beliefs like praying for health or for it to rain prevail when they clearly don't work every time. People choose to find connection in coincidence and seemingly ignore failure when it occurs. Most of these medicines arose in early societies with little or no understanding of medicine or science so yeah, if it worked once or twice it's a good bet because there's little alternative and some herbal remedies used by tribal societies are very effective against certain ailments. But modern medicine works on much stricter principles of testing and theory. And to paraphrase a very famous and probably overused quote - when alternative medicine stands up to trials and is proven to have a high degree of efficacy then it simply becomes 'medicine'.
Further to this a lot of the diseases that these treatments are 'designed' to help, such as cancer, HIV, and chronic degenerative diseases, have only really arisen in recent decades due to a vastly increased lifespan and various other cultural factors such as diet etc. As such some of the remedies being handed out as long-standing traditional treatments were never diagnostically aimed at those diseases as the diseases probably didn't exist in high enough concentration, or at all, until this century, or in the least probably weren't significantly distinguishable from other types of disease due to poor analyses of pathology.
This article doesn't seek to denounce all types of natural remedies. As one indignant commenter rightly points out most modern medicine is derived or copied from natural compounds. Instead seeks to highlight the danger in blindly using certain types of alternative medicine without proper knowledge of its effects. Similarly it scorns government for denying research into certain types of alternative treatments, like weed and acid, through blind fear of any kind of commonly used narcotics. By all means take some homeopathic energy infused water if you believe it will calm your gi or aura or whatever, but do it alongside medically prescribed treatment. A good mindset and reduced anxiety has been shown to aid in recovery and pain alleviation in numerous cases. Some might call it the placebo effect but whatever that's neither here nor there. Just don't take things that destroy the ecosystem, make beautiful creatures extinct for the sake of a quick buck to a opportunistic and desperate salesman, or give you freaking kidney failure and urinary tract failure on the sole basis that it's natural and prescribed by some ancient age old belief system.Traditions come and go. Just because it has been around for an age doesn't mean it might not be fundamentally flawed in light of new knowledge and evidence.

Avatar of: fusiondesigner

fusiondesigner

Posts: 2

September 26, 2012

I write on health topics over at http://www.healthyfoodsuppleme... which lists many uses of 'alternative' medicines.

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