Friday, March 6, 2009

Herbs and Unreason

Like many atheists, it's not just religion I have a problem with - it's evidenceless, weird things that people insist on believing, whatever their motivation. Of course, we often single out religion for special treatment because of the political power it can gather; we have yet to see people flying planes into buildings or conducting an Inquisition about moon landing conspiracy theories or psychic powers. But one of the over-riding themes of "new atheism" is that we don't have to "respect" this irrational nonsense, and we especially do not have to respect it when it's actively harmful to human beings.

Medicine is one area where people believe weird things, as the recent court decision RE autism has highlighted. (For a great summary of the cult-like behavior to date of the anti-vaccine crew, read this article at Respectful Insolence.) There have been moral conflicts far worse than that right here in the U.S.: one that I remember was in 1991, when Christian Scientists in Philadelphia who wouldn't inoculate their kids had those kids taken away when there was a measles outbreak that killed 8.

Ironically, it's exactly those areas of life where we have the most to gain from thinking clearly where humans tend to cling to tradition and evidenceless claims. Already in the nineteenth century, John Stuart Mill pointed out that medicine was an example of a market that most people didn't have the expertise to select on their own, hence the medical profession. And then, in the early 20th century, people (and especially kids) being poisoned by "medicine" was a bad enough problem that the FDA was formed to make sure that medicine is rigorously tested, so that when you take a pill, you and your doctor have a reasonable assurance a) it won't hurt you and b) it will do what it's supposed to.

That is why I have been much disturbed by the spread over the last 10-12 years of unproven herbal "remedies" for everything from depression to the common cold. Is it because I think, in principle, that things that come from plants can't possibly do any good? No; it's because these herbal remedies are rarely, if ever, tested rigorously to see if they do what we hope they do, and don't hurt us. Most herbal remedies are nonsense, whether or not they've been used by some exotic culture for millennia. Doubtless there are some which do in fact have some benefit - and indeed there have already been some incorporated into the validated pharmacopeia (aspirin and the cancer-fighting taxanes are just two examples). But we can't tell which ones are for real until we test the hell out of them. It's worth pointing out that sometimes the things you find in pretty bottles at your local homeopathic pharmacy have actually proven harmful (as in kava-related liver damage) but most of the time, they're just lawn-clippings, and exactly as effective as lawn clippings. And are even the lawn clippings truly harmless? Ask yourself whether a mother who puts her sick kid on echinacea is not doing harm; ask yourself when she sends her still-sick kid to school whether the other kids at that same school, and their parents, will think it's harmless. Think I'm being hard on the ethics of herbal supplement companies? Check out this court case. Need more? How about: Michael Savage has written books on herbal cures.

Full disclosure: I consult as a clinical research professional at biotech companies, which to many herbalists immediately invalidates my argument, because I'm obviously part of the conspiracy. To be clear, I'm not indicting the whole of plant-derived medicine. I'm indicting untested medicine. When you make claims affecting someone's health, the burden of proof on you is especially large. Therefore, herbal remedies, in order to ensure safety and efficacy, have to be tested, just like anything else; same rules apply. The Mayans took orange-honey for muscle spasms? Good for them! The classic Mayans were decent astronomers but didn't do placebo-controlled studies. So let's test it to see if they stumbled onto something. I'm always happy to add a new weapon to the proven arsenal against disease and suffering, regardless of where the inspiration came from.

I don't know why people insist on clinging to the idea of nature's goodness (like curare) necessarily being better than something that comes out of a lab (like erythromycin or ibuprofen); vitalism died over a century and a half ago, but people pretend it never happened. But now I do know why there was this explosion of herbal chicanery in the 1990s. Senators Tom Harkin (D-IA) and Orrin Hatch (R-UT) sponsored a bill (DSHEA) to remove herbals from the control of the Food and Drug Administration. What's interesting is that one of Harkin's biggest contributions come from employees of Herbalife - yes, they're in that high-rise with the green sign you see on final approach to LAX. Hatch represents one of the most religious states in the country, and as I mentioned before, in my experience in medical research, patients in Utah are the most likely to resort to herbal remedies. Steve Novella covers this in excellent detail at his blog, but it bears emphasizing that part of their bill not only deregulated herbal medicine, but established an herbal research center. Good idea, except there's no reason herbal-derived medicines should be treated any differently than any other medical research, and get their own research institute. Even worse, Harkin's idea of research is "either prove what I already believe, or you're not doing your job". Here were his exact words:

"One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving."

Harkin doesn't get it. He also must not realize that his comment reveals his true agenda. Read Novella's article for more on this endorsement of woo - with your taxpayer money.

I was once at a conference for biotechs developing medicines for the central nervous system. There was a talk by a scientists at a start-up developing Alzheimers treatments. During the Q&A at the end of the talk, a woman stood up and announced that her herbal company had developed a cure for Alzheimers. As diplomatically as possible, the presenter asked about her studies and whether she had published her data, and she angrily shot back something to the effect of "you always want data. That's the problem with medicine tody!" It was awkward to say the least. I was half-expecting security to come. Of course, I've seen the same phenomenon at work in a man at a public fair with a display claiming to disprove quantum physics.

The bottom line is that the same rules apply to a heat shock protein inhibitor developed in a lab as to a piece of bark that supposedly has anti-schizophrenia properties. To know whether it hurts you and whether it works, you have to test it. And if you think plants can't be harmful, try walking through the woods during Northern California's rainy season and eating some random mushrooms - but not before you name me as your beneficiary.

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