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Roots of Health

To some a plague, to others a godsend, herbal supplements are flying off the shelves and into the mouths of mainstream Americans By Christina Waters Scenario: Sometime in the near future. MDs are folding up practice and learning computer graphics to upgrade their employment skills. Botanical companies with names like Rain Forest Rush and Forever Young top the Fortune 500. Americans regularly spend half their monthly incomes on herbs, plankton and vitamins. Budgets are slashed for scientific research on disease control. Fewer malpractice lawsuits are balanced by increase in deaths due to herb abuse. Echinacea. Astragalus. Ginseng. Valerian. Goldenseal. Not long ago, these would have been considered the antique arsenal of apothecaries and backwater eccentrics. But in the mid-1990s, I can grab a cheap vial labeled "Tiger Ginseng" at any gas station, where I pump fossil fuels into my automobile. At Trader Joe's, I can snap up bargains in echinacea and goldenseal, right across the aisle from discounted single malt whiskeys. Ginkgo has joined the expanding vitamin shelves in Safeway markets, and valerian is available in drugstores all over the country. Have we suddenly run out of aspirin, Valium and antihistamines? Are doctors writing a mass prescription for exotic herbs? Au contraire. This growing rush to herbal judgment has very little to do at all with traditional, American Medical Association­style medicine. In fact, it might represent a collective vote of no confidence in the kindly GP of yore, and his high-priced, drug-dispensing colleagues. Heady with self-empowerment--fueled by aggressive herb and vitamin advertising claims--ordinary Americans are taking the state of their health into their own hands. A widely quoted 1993 report in the New England Journal of Medicine revealed that one in three Americans had explored some alternative therapy during the past year. The same study indicated that not only are people seeking the counsel of alternative health practitioners, they had spent--out of their own pockets, because alternative strategies are seldom covered by insurance--more than $10 billion on this care. Such a figure indicates a serious courtship between alternative health options and mainstream clients. It's no big surprise, given the current honeymoon that herbal supplements are enjoying with the self-healing public, to find that vitamins and supplements have remained the top-growth category in natural-products stores for the past three years, according to market research done by the Council for Responsible Nutrition. But the mass market also seems to be experiencing a sizable bloom of herbs and vitamins. A 1994 survey by trade consulting group Natural Foods Merchandizer puts the U.S. natural products market at around $8 billion, with vitamins and supplements as the highest growth category. The Wall Street Journal noted that supplement sales increased by almost 25 percent during the first quarter of 1994. There's no end in sight. "We've definitely seen growth in the herbal category over the last two years," says Michael Polzin, spokesperson for Walgreen's, the largest drugstore chain in the country. "And it's a nationwide trend," agrees Sharon Findley, over-the-counter category manager for Longs Drugstores. "Supplements are performing very well. The whole category of dietary supplements is up 10 percent." "The idea of natural vitamins is appealing to a lot of people," Polzin says. "There's more awareness because there's more advertising." Only the least conscious among us have failed to feel the surge of promotional froth over "natural," non-synthetic pharmaceuticals--often called botanicals or nutriceuticals. Products and magazines appear overnight, featuring a dizzying array of supplements du jour. First it was echinacea--with a grass-roots campaign so successful that even my mother now prescribes it to me when I come down with a cold. Then came melatonin, which spawned an empire of books and talk-show chatter. Now it's blue-green algaes for energy, wild yam for estrogen control and gingko to combat senility. No red-blooded American male over the age of 45 would be without his daily dose of saw palmetto, the alternative shield against prostate enlargement. More on herbal remedies, both pro and con: Echinacea fights the common cold. Ginseng keeps the body running smooth. A skeptical doctor looks at the bottom line. A Natural Reaction REASONS FOR THE high-profile affair between alternative and mainstream health agendas are abundant. Baby boomers are aging, those same baby boomers who did their own thing in their youth and already are tuned in to exploring alternative options. There's increasing distrust of drugs--the very word resonates with danger--and the anti-additive, all-natural attitude is in step with a groundswell toward sustainable lifestyles and environmental stewardship. 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 is America, the advertising campaigns have been impressive. Flip through any number 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--subtitled Action Caps. "Max your energy," the ad shouts, "with ginseng, bee pollen, sarsaparilla and licorice." The ad also points out that this product contains no ephedra (which has been linked to overdose deaths), nor does it contain caffeine (that questionable stimulant in coffee). So--in the midst of the growing prohibitionism of a culture that is anti-tobacco, anti-alcohol, anti­mind-altering drugs--we can get high on a quartet of natural substances, which the company has helpfully packaged together 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 a lab?" Laboratories are the bad guys, Dr. Frankensteinian shops from whence spring toxic substances and chemical additives. Many ads work the libido beat with photos of healthy, attractive men and women clad in outdoor exercise clothing and an aura of romance. So the natural, alternative market is growing the old-fashioned American way--with hype. What's the problem? Doin' What Comes Naturally ECHINACEA IS A LITTLE purple flower that grows wild on the North American prairie. Ginseng root has been used for 5,000 years in Chinese medicine. Increasing numbers of people flee Western technology to experiment with time-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 brain function? Could it really be this easy? And if so, why aren't we all downing daily doses of ginseng, echinacea and St. John's wort? Possibly because we're too cautious. Since 1994, herbal supplements have been legally bundled into a twilight zone category of "dietary supplement" that is neither food nor drug. As such, it may make no outright preventative or curative claims, but labeling may indicate uses and effects on bodily functions. Valerian can't claim to cure insomnia, for example, but can be labeled with wording like, "may be helpful in inducing sleep." More importantly, dietary supplements are not held to the same testing standards as required of drugs by the FDA. Drugs must undergo double-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 simply watchdog paternalism vs. freedom of choice? Or is it something that looks and sounds a whole lot like greed? In a paper he recently presented to the National Institute of Health's new Office of Alternative Medicine, herb honcho Rob McCaleb theorized that the demand for strict scientific regulation of herbal supplements was hindering access to traditional healing techniques. The price of all the rigorous testing to meet FDA approval can be as high as $300 million, according to McCaleb and other experts in his field. The inventors of Prozac probably wouldn't mind that kind of investment, given the juicy patent waiting at the end of the laboratory trail. But what if it turned out that a daily dose of milk thistle could achieve the same anti-depressant results for a fraction of the price and no prescription needed? "Yes, that's why double blind testing isn't done for something like echinacea," says McCaleb, founder of the Colorado-based Herb Research Foundation and a recent appointee to the Presidential Commission on Dietary Supplements. "Nobody gets a payoff." Patent medicines are just that--medicines that have been synthetically created, and whose chemical formulae have been patented. He who patents, prospers. Because no one can patent an herb, no one can exclusively profit from it. Hence, no one stands to gain by proving--through long, costly testing--that Herb X cures cancer. Nobody, except cancer patients and their families, that is. So far, claims for botanicals and herbs remain primarily anecdotal--accounts of trial and error, personal sagas of use and effectiveness--rather than empirical test results that can be re-tested and verified in labs anywhere in the world. In a capital-driven society, what generates patented profits is what we get. Quackery and the 'Sick Care' System NONSENSE, SAYS Dr. William Jarvis, director of the National Council Against Health Fraud Inc. "It's only because we've had strong food and drug laws in this country that the American pharmaceutical industry has become the world leader in its field," says the charlatan hunter. "It's not because they are angels from heaven. It's just that they've had to meet the law." Jarvis, professor of consumer health education at Loma Linda University and renowned thorn in the side of those who champion herbal alternatives, feels that botanicals' lack of standardized testing is a clear case of industrial laziness. "If they test them, maybe they'll find that they don't really do anything. 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 can create the illusion that you've built a better mousetrap, the world will beat a path to your door. As long as you can keep the illusion alive, it's just as effective as if you'd actually built the mousetrap." Obviously many disagree with Jarvis' grouse about the ineffectiveness of herbs and they welcome the growing numbers of cross-over health seekers and practitioners. "We know pediatricians who are recommending echinacea to their kids for colds and sore throats," McCaleb says. "Some doctors are turning their patients on to valerian instead of benzodiazotenes. And it's because people are increasingly concerned that what we have in the U.S. is a 'sick care' system, instead of a health care system--we wait until disease has set in and then look for dramatic interventions." McCaleb points to the provincialism of American attitudes. "In the European market, when synthetic and botanical medicines are sold side by side, the natural remedies outsell the synthetics almost every time. When people have a choice, they just trust the natural more." Critics note with chagrin that all too often consumers equate "natural" with "safe." And McCaleb, weary of all the high-profile press condemning botanicals as unsafe because untested, likes to remind consumers that the same doctors who won't go on the record about the benefits of vitamin E "are themselves taking vitamin E for cardiovascular protection." McCaleb admits that consumers are demanding greater "quality and potency and consistency in natural remedies. And the industry is responding." He also agrees that the current glut of glitzy advertising stands to blur integrity of claims. "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 to the Dietary Supplement Health and Education Act of 1994 will improve the situation by "examining supplement regulation and recommending changes to the labels--to make them more informative and science-based. "The mainstream," says the respected ethnobotanist, "has definitely begun to take an interest in herbal supplements." Lasting Solutions IF YOU THINK that's just a facile claim by a professional in the alternative health field, try firing up your modem and key up your favorite search engine with the words "alternative health." Not only is there enough botanical lore, research and archival material available on the World Wide Web to give every one of us a degree in pharmacognosy, but there are growing numbers of respected 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 the fields of herbal therapy for the past several decades--waiting for the rest of 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 should always have been. People should always use herbs before they go to drugs. If the 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 care of 85 to 90 percent of the problems that most people are having with their health." Tierra, a pioneer herbal therapist, author of the much-reprinted Way of Herbs 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 other solutions and those solutions are here to stay because people are getting results." Tierra believes any negative effects due to herbal ingestion is "incredibly minuscule, especially compared to over-the-counter prescriptions," he states emphatically. "I don't think regulation is required. People will always find all kinds of ways to hurt themselves. It's just not necessary to regulate most herbs," he says. For Tierra, the real danger involved in this debate is that "if we don't have a voice as professionals in the herbal field--like we now have with the presidential commission--then someone else will do the regulating for us." Such insistence on freedom of choice is "just a stupid way of thinking" to Jarvis. "It's just folly. You're putting something in people's hands that has a great potential for harm and then saying, well, anybody should be able to 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 some guidance on the question of regulating dietary supplements, Jarvis scoffingly agrees with Tierra. "It's definitely an industry group. It's stacked with the leading advocates and those who stand to gain from the marketing of these products, like the Herb Research Foundation." Boom or BS WILLIAM JARVIS IS happy to trash the prevailing theories that aging boomers or failure of confidence in medical doctors have generated the herbal boom. "There is no boom--at least not among consumers. The boom is among marketers," Jarvis laughs. "What you have here is a very interesting set of developments: In 1962 when the Kefauver-Harris amendment was passed requiring proof 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 taking products off the market by the hundreds that hadn't met the efficacy standard. Into this vacuum of essentially useless products, 60 companies petitioned the FDA to market homeopathic products--a lot of which are herbal--and then the herbal market took off. And now we have the new dietary-supplement law. What happened was that the marketers got the government to acknowledge categories that did not have to meet the efficacy requirement. And these products are moving into the void left by pulled standard products. So you have a marketplace phenomenon going on here--anybody thinks that this is a consumer thing is naive." Despite the emotional rhetoric on both sides of the issue, it seems clear that sales and use of herbal supplements will continue. And the intensified interest by McCaleb and other botanical professionals in seeking scientific credibility parallels the traditional health community's interest in educating consumers about all their options. Even Jarvis believes there should be a different category created for herbal medicines. "I don't think you have to take each product and test it on a randomized, controlled clinical trial," he says. "But if you work from the basic constituents and the pharmacological knowledge of those, and have a provision to track unanticipated adverse effects, then I think you could go forward with it." Judging from McCaleb's recommendations to the National Institutes of Health and the recent National Council Against Health Fraud position paper on over-the-counter herbal remedies, the two camps are moving closer to accord. Both urge something less costly than full double-blind testing, suggesting "realistic standards of evidence for established plant medicines," as McCaleb's paper words it. In its detailed listing of recommendations to bring greater credibility and safety to the herbal medicine market, the NCAHF paper states that "many [over-the-counter] herbal remedies could be marketed without costly and lengthy clinical trials if basic principles of consumer protection are attended to. While caveat emptor should still be the consumer's guiding principle, it will be that same consumer who wins should the warring factions--those who want to provide informed access to life-enhancing substances, and those who want to protect the innocent from potential folly--meet each other halfway. "There's nothing new here," says Jarvis. "People have been interested in fighting off the effects of aging, extending their lives, enjoying sex and mental performance and physical performance as far back as we have history. People are people and we all want to be better-looking and younger and faster forever. The universal appeal goes back to the Garden of Eden, the snake and the apple--the idea that you'll live forever and be like the gods. You know," he chuckles, "that's where it all started." Related information is available on the web in the files of the Herb Research Foundation and the archives of the National Council Against Health Fraud. [ Metro | Metroactive Central | Archives ]