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Supplemetal Income: Pioneer herbal therapist Michael Tierraattributes the upswing in mainstream interest in herbal cures to "theinadequacy of conventional medicine. People are looking for other solutions,"he says. "And those solutions are here to stay because people are gettingresults."
To some a plague, to others a godsend, herbal remedies are flying off theshelves and into the mouths of mainstream Americans
By Christina Waters
Scenario: Sometime in the near future. MDs are folding uppractice and learning computer graphics to upgrade their employment skills.Botanical companies with names like Rain Forest Rush and Forever Young topthe Fortune 500. Americans regularly spend half their monthly incomes onherbs, plankton, and vitamins. Budgets are slashed for scientific research ondisease control. Fewer malpractice lawsuits are balanced by increase indeaths due to herb abuse.
IT MAY NOT BE SO FAR-FETCHED. Echinacea. Astragalus. Ginseng. Valerian.Goldenseal. Not long ago, these herbal remedies would have been consideredthe antique arsenal of apothecaries and backwater eccentrics. In themid-1990s, I can grab a cheap vial labeled "Tiger Ginseng" at almost any gasstation. At Trader Joe's in Santa Rosa, I can snap up bargains in echinaceaand goldenseal, right across the aisle from discounted single-malt whiskies.Ginkgo has joined the expanding vitamin shelves in Safeway markets, andvalerian is available in drugstores all over the country.
Have we suddenly run out of aspirin, Valium, and antihistamines? Are doctorswriting a mass prescription for exotic herbs? Au contraire. This growing rushto herbal judgment has very little to do at all with traditional, Western,AMA-style medicine. In fact, it might represent a collective vote of noconfidence in the kindly GP of yore, and his high-priced, drug-dispensingcolleagues.
Heady with self-empowerment--fueled by aggressive herb and vitaminadvertising claims--ordinary Americans are taking the state of their healthinto their own hands. A widely quoted 1993 report in the New EnglandJournal of Medicine revealed that a whopping one in three Americans hadexplored some alternative therapy during the past year. The same studyindicated that not only were people seeking the counsel of alternative healthpractitioners, but they had spent--out of their own pockets, sincealternative strategies are seldom covered by insurance--over $10 billion onthis care. Such a figure indicates a serious courtship between alternativehealth options and mainstream clients.
It's no big surprise, given the current honeymoon herbal supplements areenjoying with the self-healing public, that vitamins and supplements haveremained the top-growth category in natural products stores for the pastthree years, according to market research done by the Council for ResponsibleNutrition.
But the mass market also seems to be experiencing a sizable bloom of herbsand vitamins. A 1994 survey by trade consulting group Natural FoodsMerchandizer puts the U.S. natural products market at around $8 billion, withvitamins and supplements as the highest growth category. The Wall StreetJournal noted that supplement sales increased by almost 25 percent duringthe first quarter of 1994. There's no end in sight.
"We've definitely seen growth in the herbal category over the last twoyears," says Michael Polzin, spokesperson for Walgreen's, the largestdrugstore chain in the country. "The idea of natural vitamins is appealing toa lot of people," Polzin says. "There's more awareness because there's moreadvertising."
"And it's a nationwide trend," agrees Sharon Findley, over-the-countercategory manager for Longs Drugstores. "Supplements are performing very well.The whole category of dietary supplements is up 10 percent."
Sonoma County--home to the acclaimed California School of Herbal Studies inForestville, the Shaman Healing and Massage Center in Santa Rosa, and theSebastopol-based Traditional Medicinals herbal tea company--is a bastion ofnatural cures. Local health food stores and quality supermarkets--includingRosemary's Garden, Fiesta Market, and Nicole's Health Food Store inSebastopol; Food for Humans in Guerneville; Oliver's Market in Cotati;Organic Grocers and Community Market in Santa Rosa; Petaluma Natural Foods;and the Food for Thought chain--maintain well-stocked herbal remediessections.
Only the least conscious among us has failed to feel the surge of promotionalfroth over "natural," non-synthetic pharmaceuticals--often called botanicalsor nutriceuticals. Products and magazines appear overnight, featuring adizzying array of supplements du jour. First it was echinacea--with agrassroots campaign so successful that even my mother now prescribes it to mewhen I come down with a cold. Then came melatonin, which spawned an empire ofbooks and talk-show chatter. Now it's blue-green algae for energy, wild yamfor estrogen control, and gingko to combat senility. No red-blooded Americanmale over the age of 45 would be without his daily dose of saw palmetto, thealternative shield against prostate enlargement.
For detailed information, access the huge and informative files of the Herb Research Foundation or consultthe vast archives of the National CouncilAgainst Health Fraud.
A Natural Reaction
Reasons for the high-profile affair between alternative and mainstream healthagendas are abundant. Baby boomers are aging, the same baby boomers who didtheir own thing in their youth and already are tuned in to exploringalternative options. There's increasing distrust of drugs--the very wordresonates with danger--and the anti-additive, all-natural attitude is in stepwith a groundswell toward sustainable lifestyles and environmentalstewardship.
But lest you think this is all an altruistic, love-and-peace proposition,keep in mind that big bucks are the bottom line here. And since this isAmerica, the advertising campaigns have been impressive. Flip through anynumber of the new publications--bearing titles like Health, Delicious,Eating Well, The Natural Way--and be dazzled by the ads.
There's no mistaking the message of a product called Rocket Fuel--subtitledAction Caps. "Max your energy," the ad shouts, "with ginseng, bee pollen,sarsaparilla and licorice." The ad also points out that this product containsno ephedra (which is also known as ma huang and has been linked to overdosedeaths), nor does it contain caffeine (that questionable stimulant in coffee,tea, cola, and even cocoa).
So--in the midst of the growing prohibitionism of a culture that isanti-tobacco, anti-alcohol, anti-mind-altering drugs--we can get high on aquartet of natural substances, which the company has helpfully packagedtogether for us. I'm getting the picture. Another ad pulls another string."Would you pick your phyto nutrients from the earth," it asks coyly, "or alab?" Laboratories are the bad guys, Dr. Frankensteinian shops from whencespring toxic substances and chemical additives. Many ads work the libido beatwith photos of healthy, attractive men and women clad in outdoor exerciseclothing and an aura of romance.
So the natural, alternative market is growing the old-fashioned American way,with hype--what's the problem?
Echinacea is a little purple flower that grows wild on the North Americanprairie. Ginseng root has been used for 5,000 years in Chinese medicine.Increasing numbers of people flee Western technology to experiment withtime-honored, plant-based nutrients, which all seem simpler, more romantic.Who doesn't want to strengthen their immune system, improve their vision,enjoy more stamina, sleep better, slow the aging process, and increase brainfunction? Could it really be this easy? And if so, why aren't we all downingdaily doses of ginseng, echinacea, and St. John's wort? Possibly becausewe're too damn cautious.
Since 1994, herbal supplements have been legally bundled into a twilight zonecategory of "dietary supplement" that is neither food nor drug. As such, itmay make no outright preventative or curative claims, but labeling mayindicate uses and effects on bodily functions. Valerian can't claim to cureinsomnia, for example, but can be labeled with wording like "may be helpfulin inducing sleep." More important, dietary supplements are not held to thesame testing standards as required of drugs by the FDA. Drugs must undergodouble-blind, randomized testing. Drugs must provide documentation about use,safety, ingredients, indications, warnings, and dosage.
Herbal supplements require no such regulation.
But what's really causing the vociferous battle in the media (Newsweek,Consumer Reports, Herbalgram) over natural vs. FDA-approved? Is it simplywatchdog paternalism vs. freedom of choice? Or is it something that looks andsounds a whole lot like greed?
In a paper he recently presented to the National Institute of Health's newOffice of Alternative Medicine, herb honcho Rob McCaleb theorized that thedemand for strict scientific regulation of herbal supplements was hinderingaccess to traditional healing techniques. The price of all the rigoroustesting to meet FDA approval can be as high as $300 million, according toMcCaleb and other experts in his field. The inventors of Prozac probablywouldn't mind that kind of investment, given the juicy patent waiting at theend of the laboratory trail.
But what if it turned out that a daily dose of St. John's wort could achievethe same anti-depressant results for a fraction of the price and noprescription needed?
"Yes, that's why double-blind testing isn't done for something likeechinacea," says McCaleb, founder of the Colorado-based Herb ResearchFoundation and recent appointee to the Presidential Commission on DietarySupplements. "Nobody gets a payoff."
Patent medicines are just that--medicines that have been syntheticallycreated, and whose chemical formulae have been patented. He who patents,prospers. It's because no one can patent--i.e., own--an herb; no one canexclusively profit from it. Hence, no one stands to gain by proving--throughlong, costly testing--that Herb X cures cancer. Nobody, except cancerpatients and their families, that is.
So far, claims for botanicals and herbs remain primarily anecdotal--accountsof trial and error, personal sagas of use and effectiveness--rather thanempirical test results that can be retested and verified in labs anywhere inthe world. In a capital-driven society, what generates patented profits iswhat we get.
Supporting Evidence: New studies back claims of the curativepowers of such herbal remedies as echinacea.
The 'Sick Care' System
Nonsense, says Dr. William Jarvis, director of the National Council AgainstHealth Fraud Inc. "It's only because we've had strong food and drug laws inthis country that the American pharmaceutical industry has become the worldleader in its field," says this hunter of charlatans. "It's not because theyare angels from heaven. It's just that they've had to meet the law."
Jarvis, professor of consumer health education at Loma Linda University andrenowned thorn in the side of alternative health claims, feels thatbotanicals' lack of standardized testing is a clear case of industriallaziness. "If they test them, maybe they'll find that they don't really doanything. It's kinda like this old saying, 'If you build a better mousetrap,the world will beat a path to your door.' Well, in quackery, if you cancreate the illusion that you've built a better mousetrap, the world will beata path to your door. "As long as you can keep the illusion alive, it's justas effective as if you'd actually built the mousetrap."
Obviously many disagree with Jarvis' grouse about the ineffectiveness ofherbs and they welcome the growing numbers of cross-over health seekers andpractitioners. "We know pediatricians who are recommending echinacea to theirkids for colds and sore throats," says McCaleb. "Some doctors are turningtheir patients on to valerian instead of benzodiazotenes. And it's becausepeople are increasingly concerned that what we have in the United States is a'sick-care' system, instead of a health-care system--we wait until diseasehas set in and then look for dramatic interventions."
Herbalists offer "the major answer to the health-care problem," saysherbalist James Green of Forestville's California School of Herbal Studies.Commonly prescribed drugs have produced a virtual epidemic of dire sideeffects. For example, 20 of the more than 250 prescription drugs thatshouldn't be used by older adults account for 80 million prescriptionspurchased by that same population--to the tune of more than $1 billion ayear. The usually affable Green is hardly sanguine when he talks about themedical and pharmaceutical industries, which, despite their unsavory recordand with the blessing of the FDA, are allied in defending their turf againstinroads being made by alternative therapies such as herbalism. The medicaland drug behemoths would like to convince the public that herbalism is basedon faith and whimsical logic, Green says, and they submit "shoddy evidencethat certain herbs are lethal. But herbs are powerful, and one must know howto use them."
McCaleb points to the provincialism of American attitudes. "In the Europeanmarket, when synthetic and botanical medicines are sold side by side, thenatural remedies outsell the synthetics almost every time. When people have achoice, they just trust the natural more." Critics note with chagrin that alltoo often consumers equate "natural" with "safe." And McCaleb, weary of allthe high-profile press condemning botanicals as unsafe because untested,likes to remind consumers that the same doctors who won't go on the recordabout the benefits of Vitamin E "are themselves taking vitamin E forcardiovascular protection."
McCaleb admits that consumers are demanding greater "quality and potency andconsistency in natural remedies. And the industry is responding." He alsoagrees that the glut of glitzy advertising stands to blur integrity ofclaims. "Everybody's trying to get the consumer's attention in a louder way,"he says.
Meanwhile, McCaleb is convinced that the new commission formed in response tothe Dietary Supplement Health and Education Act of 1994 will improve thesituation by "examining supplement regulation and recommending changes to thelabels--to make them more informative and science-based. The mainstream,"says the respected ethnobotanist, "has definitely begun to take an interestin herbal supplements."
If you think that's just a facile claim by a professional in the alternativehealth field, try firing up your modem and key up your favorite search enginewith the words "alternative health." Not only is there enough botanical lore,research, and archival material available on the World Wide Web to give everyone of us a degree in pharmacognosy, but there are growing numbers ofrespected medical schools now offering courses in alternative therapies,herbal medicine, and Eastern healing techniques.
And this is just as it should be for those who've paid their dues in thefields of herbal therapy for the past several decades--waiting for the restof the world to catch on.
"I think the increased attention to herbal supplements is a wonderful,incredible thing," says herbalist Michael Tierra. "That's the way it shouldalways have been. People should always use herbs before they go to drugs. Ifthe herbs aren't helping them, and they're not getting the results they need,then they should look for other means. But I figure that herbs can take careof 85 to 90 percent of the problems that most people are having with theirhealth."
Tierra, a pioneer herbal therapist, author of the much-reprinted Way ofHerbs and teacher at Santa Cruz's East/West Herb and Acupuncture Center,says there's a single reason for the current revival of herbal alternatives:"The inadequacy of conventional medicine. People are looking for othersolutions, and those solutions are here to stay because people are gettingresults."
Tierra emphatically states that any negative effects due to herbal ingestionare "incredibly minuscule, especially compared to over-the-counterprescriptions. I don't think regulation is required. People will always findall kinds of ways to hurt themselves. It's just not necessary to regulatemost herbs," he says.
For Tierra, the real danger involved in this debate is that "if we don't havea voice as professionals in the herbal field--like we now have with thepresidential commission, then someone else will do the regulating for us."
Such insistence on freedom of choice is "just a stupid way of thinking," toDr. Jarvis. "It's just folly. You're putting something in people's hands thathas a great potential for harm and then saying, well, anybody should be ableto do as they please. You don't let children play with firearms or poisons."
As for the presidential commission that's been formed to provide someguidance on the question of regulating dietary supplements, Jarvis scoffinglyagrees with Tierra. "It's definitely an industry group. It's stacked with theleading advocates and those who stand to gain from the marketing of theseproducts, like the Herb Research Foundation."
Boom or BS
William Jarvis is happy to trash the prevailing theories that aging boomersor failure of confidence in medical doctors have generated the herbal boom."There is no boom--at least not among consumers. The boom is amongmarketers," Jarvis laughs. "What you have here is a very interesting set ofdevelopments: In 1962 when the Kefauver-Harris amendment was passed requiringproof of efficacy of drug products, a lot of products were grandfathered.They were given time to get their act together, essentially.
"Then in the late '80s and early '90s," he lectures, "the FDA began takingproducts off the market by the hundreds that hadn't met the efficacystandard. Into this vacuum of essentially useless products, 60 companiespetitioned the FDA to market homeopathic products--a lot of which areherbal--and then the herbal market took off. Now we have the the new DietarySupplement law.
"What happened was that the marketers got the government to acknowledgecategories that did not have to meet the efficacy requirement. And theseproducts are moving into the void left by pulled standard products.
"So you have a marketplace phenomenon going on here--anybody who thinks thatthis is a consumer thing is naive."
Despite the emotional rhetoric on both sides of the issue, it seems clearthat sales and use of herbal supplements will continue. And the intensifiedinterest by McCaleb and other botanical professionals in adding scientificcredibility to claims parallels the traditional health community's interestin educating consumers about all their options.
Even Jarvis believes there should be a different category created for herbalmedicines. "I don't think you have to take each product and test it on arandomized, controlled clinical trial," he says. "But if you work from thebasic constituents and the pharmacological knowledge of those, and have aprovision to track unanticipated adverse effects, then I think you could goforward with it."
Judging from McCaleb's recommendations to the National Institutes of Healthand the recent National Council Against Health Fraud position paper onover-the-counter herbal remedies, the two camps are moving closer to accord.Both urge something less costly than full double-blind testing, requesting"realistic standards of evidence for established plant medicines," asMcCalebs notes.
In its detailed listing of recommendations to bring greater credibility andsafety to the herbal medicine market, the NCAHF paper states that "many[over-the-counter] herbal remedies could be marketed without costly andlengthy clinical trials if basic principles of consumer protection areattended to. While caveat emptor should still be the consumer's guidingprinciple, it will be that same consumer who wins, should the warringfactions--those who want to provide informed access to life-enhancingsubstances, and those who want to protect the innocent from potentialfolly--meet each other halfway.
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From the January 16-22, 1997 issue of the Sonoma County Independent
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