How does our obsession with ‘evidence based’ medicine affect you?

Despite literally being as old as the hills, Herbal Medicine is often criticised for lacking evidence of its efficacy. It’s mainly those within the scientific and medical community who demand ‘evidence’, and its the reason given for the reluctance of those communities to work with Herbal Medicine and Medical Herbalists. The problem is, particularly with the pressure the NHS is under now, there’s huge potential for Herbal Medicine to be integrated in with conventional medicine, but no willingness to do so despite the potential cost savings. Over the years, my colleagues and I have helped to save the NHS money by treating patients who’ve responded so well, they no longer needed repeated GP appointments, trips to A&E, ambulance call outs, long term medication, or even in some cases, surgery. One anxiety patient I’ve seen recently was calling ambulances on a weekly basis for her panic attacks. Each callout would have cost the NHS  anywhere up to £250, but she hasn’t called any more since she started herbal treatment. Others with chronic conditions like Fibromyalgia which tend to need numerous GP and hospital appointments, but respond poorly to conventional treatment, often do very well on herbs.

Whilst I’m in no doubt that the ability of herbs to treat illness goes way beyond our current understanding, I’m also convinced

Medical Herbalist

Longer consultation times usually get quicker results.

that there’s more at play when a patient recovers after taking them. Herbal medicine has always maintained the human touch which Doctors struggle more and more to provide these days. Each patient is treated as a unique individual. Time and care is taken to listen to their story, examine them thoroughly, and offer the best possible care. Whilst Doctors strive to do the same, many of my Doctor friends find themselves increasingly frustrated that time pressures and protocol prevent them from offering this same level of care. Equally patients become despondent and many go in search of a Medical Herbalist who can spend the time and effort required to make them feel truly cared for. Despite the costs, they feel more at ease with their situation, and empowered to do something about it. That inevitably goes a very long way towards aiding their recovery and most would agree that it was money well spent.

Why Herbal Medicine Isn’t All Placebo

Placebo

The actions of herbs cannot be explained as placebo.

I can’t deny that placebo, where a person gets better simply because they think they will, has an important role to play in herbal treatment. I started studying the mind-body connection with illness before I ever came to herbal medicine, and I fully appreciate how powerful it can be. That’s why I make full use of it in my practice, by exploring with patients the psycho-emotional aspects of their health issues, and encouraging them to keep an open mind regardless of what prognosis they may have been given before. Medical Herbalists and Doctors alike will be able to tell you about patients who’ve defied all the odds and made a totally remarkable recovery, so I’m convinced that ‘cure’ depends more on the individual patient than the illness itself.

As for the herbs, you could take any one of those commonly used by Medical Herbalists and subject it to scientific analysis which would help to explain how the active constituents work. The definition of a placebo in medicine terms is something inert, like water, which can’t possibly have any influence over the course of illness. That alone makes herbs a non-placebo. How can any plant which can be scientifically analysed for its active constituents also be inert? And how can plants from which modern pharmaceuticals have been derived also be placebo?

In practice I often find that some herbal prescriptions work better than others in the same patient, regardless of how much they want to get well. That can’t be placebo. Likewise I’ve seen herbs work in newborn babies who are completely unaware that they’re even taking them. That can’t be placebo either. In any case, by dismissing a person’s recovery as pure placebo, we’re offending the person and missing the point. What matters most is that the patient recovered, the means by which they did is less important. Even some Doctors agree that we both misunderstand, and under-use the power of placebo to our cost!

The Problems With Evidence In Herbal Medicine

There are several reasons why it’s difficult to get good quality evidence supporting the efficacy of herbal medicines, a main one being funding. Clinical trials are very expensive, and its difficult to justify costs unless there’s a potential profit, or significant saving to be made.

Herbs are not drugs! Pharmaceuticals work on a ‘one size fits all’ basis. For example, if a new drug was being developed to treat migraines, we might test it on 1000 people where 500 were given the drug and the other were given a placebo (an inert substance). Neither the people taking the treatment or those giving it to them would know who was taking the real drug and who was taking the placebo. If significantly more responded to the drug than the placebo, it would prove that the drug was literally better than nothing and worth putting on sale.

Herbs as prescribed by Medical Herbalists work quite differently. Herbal medicine relies on the synergy of all consituents in the plant working together. We use the whole plant for the whole person rather than one isolated constituent for all. The medicine may be made up from several herbs and is personalised to the patient depending on what the Medical Herbalist feels are the underlying causes of their condition. If we took the same 1000 migraine patients, and gave them each a consultation with a Medical Herbalist, each would get a very different herbal prescription and treatment plan. It’s impossible to subject this form of treatment to the same clinical trials as drugs, although we can use other models like MYMOP to monitor how well each patient feels they’re doing on their regime.

Most Patients Don’t Care About Evidence

Interestingly, not once in 18 years of practice has a potential patient, including the doctors and the scientists ever asked me for ‘evidence’ that Herbal Medicine works. Many have already got their own evidence from seeing friends and family do well on treatment. Only one has come purely to vet me with regard to my training and experience. He was apologetic and very thorough, and I reassured him that I was pleased he was going to such lengths to ensure that I was safe and competent to work with, especially since the Government reversed its decision to regulate us (we’re too safe to need it!).

And as for ‘evidence’, Herbal Medicine gets 0.1% of the global research budget. As Medical Herbalists we would of course welcome more funding and more research, but not having that isn’t a barrier to us offering the same effective treatment we always have. Despite the lack of funding, there are actually a surprising number of good quality studies proving the safety and efficacy of Herbal Medicine for those who care to look.

Lack Of ‘Evidence’ As A Barrier To Integrated Healthcare

I’d love nothing more than to see Herbal Medicine along with various other CAM treatments integrated in with mainstream healthcare, for the benefit of all concerned. Having observed the situation over a number of years I’m inclined to believe that no amount of ‘evidence’ will ever be enough to convince the NHS that working with Medical Herbalists will benefit Doctors and more importantly patients. In fact in April this year they banned Homeopathy and Herbal Medicine from the Royal London Hospital For Integrated Health on cost saving grounds. Interestingly, the cost savings here are negligible compared to other areas.

Studies like this one from Somerset indicate the potential cost savings which come from integrating complementary and conventional treatments. Another herbal practice in Edinburgh receives a number of GP referrals for the benefit of all concerned. Patients there are offered consultations at reduced cost, as well as the opportunity to learn how to make their own simple medicines. Whilst the cost savings have not been formally recorded yet (ironically it’s too costly to count costs!), this model does have the full support of the GPs as it has reduced their workload and benefited patients at the same time. Human experience is valid, especially where there’s a lack of statistics, and anecdotal evidence, especially from a Doctor, should still count as evidence.

Dr Aseem Malhota says in this talk that modern medical research is now so biased that it’s impossible to treat it as true ‘evidence’ upon which Doctors can safely advise patients. His opinions are backed by Editors of the New England Journal of Medicine, and the Lancet. Both have concerns about the hidden agendas of those funding and presenting this research, and the impact it has upon decisions made by Doctors and patients. Richard Horton, Editor of the Lancet, believes that up to half of all research papers published there may in fact be untrue.This makes a mockery of ‘evidence’ for current medical treatments in general, and provides a very weak position from which to criticise herbal medicine.

Certainly when I’ve spoken to Doctors who’ve trained in parts of Asia where integration between traditional and modern medicine is mainstream, none have been able to understand our obsession with ‘evidence based’ medicine in the west. Many choose not to openly share this opinion with their UK trained colleagues for fear of reprisal, but increasingly Doctors are leaving the NHS and taking pay cuts to train as Medical Herbalists. That, along with seeing the every day miracles worked by herbs throughout my career, is all the evidence I need.

 

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