 Hello again. I'm Dr. Harriet Hall, and this is lecture 6 in a series of 10 lectures on science-based medicine. The topic of this lecture is naturopathy and herbal medicine. For a long time, I wasn't sure exactly what naturopathy meant. When people ask me what is chiropractic, I had no difficulty answering. But when they ask me what is naturopathy, I found it very hard to explain. I finally realized it wasn't my fault. It was the fault of naturopathy because naturopathy is so vague and incoherent. Here's how naturopaths define themselves. Naturopathic medicine is a distinct primary health care profession emphasizing prevention, treatment, and optimal health through the use of therapeutic methods and substances which encourage the person's inherent self-healing process, the vis-medicatrix-naturi. Now, the words I highlighted in red take us out of the realm of science and reality. There is no one inherent self-healing process. There are lots of different physiologic processes that repair wounds and maintain the status quo of various different physiologic systems by various different mechanisms. The term vis-medicatrix-naturi comes straight out of the pre-scientific concept of vitalism, the idea that there is something like a soul or a vital spark that has to be added to matter to create life. Vitalism was long ago rejected by both philosophy and science. Science accepts that life is an emergent property of physical and chemical processes. Naturopathy is a mixed bag and that's why it's hard to pin down, but it's loosely unified by these principles. Avoidance of drugs and surgery, use of natural treatments, emphasis on prevention, and vitalistic philosophy. It claims to be based on science, but it's inconsistent with mainstream science-based medicine. It offers some sensible advice about nutrition, exercise, and so on. But it's riddled with quackery. Science-based medicine is unified. It has one standard of practice based on the best available evidence. Naturopathy is so nebulous that it allows its practitioners to believe and do almost anything. If the same patient went to five naturopaths, he would very likely get five completely different diagnoses and treatment regimens. Some credit Hippocrates is the first naturopath, but modern naturopathy was invented by a man named Benedict Lust. Here he is in the flesh. Near the end of the 19th century, he got sick and he thought he had tuberculosis, but he probably didn't. Anyway, he went to Germany and he was treated with a water cure and he became enamored of natural treatment methods. In 1901, Lust purchased the rights to the word naturopathy from a man named John Shield and he founded the first naturopathic school. He advocated massage, hydrotherapy, herbal medicine, avoidance of caffeine and alcohol, and nude sunbathing. He was arrested 19 times during his career. I wonder how many of those arrests were for practicing medicine without a license and how many were for public nudity. The heyday of naturopathy was the early 20th century. At the peak of its popularity, naturopaths were licensed in 25 states. Now, the year 1900 was a dividing line. Before that, you stood only a 50-50 chance of benefiting from an encounter with a conventional doctor. They were just as likely to harm as to help. So it's easy to see the attraction of naturopathy. But as the 20th century progressed and mainstream medicine became more effective, people lost interest in naturopathy. By 1958, it was only licensed in five states. Now it's had a resurgence with the CAM movement. Today, it's licensed in 17 states. And in two states, naturopathic doctors have full prescribing rights in Washington and Oregon. Licensing legislation has been repeatedly introduced in at least 10 more states. These attempts have repeatedly failed as many as 10 times in a row. Naturopathy was recently de-licensed in Idaho. And it's still prohibited by law in two states, South Carolina and Tennessee. In the remaining 31 states where it's not either licensed or prohibited, naturopaths can theoretically be convicted of illegally practicing medicine without a license. But that seldom happens. What do you call a naturopath? Well, if a naturopath has a degree granted by an accredited school of naturopathy, he's authorized to use the title Doctor of Naturopathic Medicine, or ND. In Arizona, he can call himself a naturopathic medical doctor, or NMD. In other jurisdictions, naturopathic doctor, naturopathic physician, or naturopath. If he has no degree or a degree in traditional naturopathy from unaccredited correspondence courses, then he can call himself ND in states where the title of naturopath or ND is not protected and can be used by anyone. But in states that license naturopaths, he can't use the title. Some people say that ND stands for not a doctor. There are five accredited schools in the U.S. and two in Canada. Accreditation only means that the school meets certain administrative standards. It doesn't mean that what's taught is valid, or even that it has any connection to reality. And naturopaths are in charge of accrediting their own schools. The prerequisite for admission is an undergraduate education with an emphasis on science. The curriculum lasts for four years. They claim that it contains more basic science than MDs. But it also includes nonsense like homeopathy, iridology, color therapy, colon therapy, and aroma therapy. Naturopathy students get no hospital experience with seriously ill patients. And they have no experience with prescription medications. You can get a nonaccredited naturopathy diploma from a correspondence course. In a typical course, there are no admission requirements beyond a high school diploma. There are 15 installments with a total tuition cost of $3,195. It typically takes two years to complete. The curriculum includes no science to speak of. There are classes on things like buck flower remedies, reflexology, aroma therapy, applied kinesiology, and homeopathy, and lots of bogus diagnostic tests. There are no instructors to answer questions. Students who initially failed tests are helped to pass them. They're allowed to keep retaking the questions they missed until they get them right. And there's no final exam. And in states where MDs are not licensed, these people are getting away with calling themselves naturopaths and with practicing medicine without a license. This is a standard naturopathy textbook, 2,000 pages long. It was authored by the president of Bastere University, the most prestigious school of naturopathy. Arnold Rellman, former editor of the New England Journal of Medicine, reviewed the 1999 edition of this textbook, and he found that it covered only 70 health problems listed in alphabetical order. In contrast to medical textbooks that list hundreds of diseases organized systematically. This textbook omits many serious diseases like cancer, heart attacks, kidney disease, tuberculosis, and meningitis. It lists treatments that are not likely to be effective. It omits treatments that are known to be effective. It makes claims for herbal remedies with little or no supporting evidence. And it offers dangerous advice. Rellman concluded, judging by the standards of practice presented in this textbook, it seems clear that the risks to many patients seeking care from the average naturopathic practitioner would far outweigh any possible benefits. The textbook still teaches the four humors. The idea of the four humors was an early attempt to understand how the body worked. It recognized four bodily fluids, blood, yellow bile, black bile, and phlegm. It attributed diseases to an imbalance of those fluids. Hippocrates and medieval doctors believed in it, but it's been completely superseded by scientific knowledge, and it's nothing but a historical curiosity. Yet incredibly, it's still being taught to naturopaths. This edition of the textbook, Natural Medicine, contains a whole chapter on Yunani medicine, which is basically the Greek philosophy of humors with a few contributions from Islam and folk medicine. Over two pages are devoted just to describing the physical manifestations of the humors. It tells the student that people who are sanguine, dominated by blood, have urine that is rich or bright yellow and thick. The choleric, dominated by yellow bile, have urine that is scanty, dark, thin, and can be hot or burning. The melancholic, black bile, are light sleepers. The phlegmatic are deep sleepers, and they tend to snore. Here are just a few of the treatment recommendations from the textbook. For asthma, hydrogen peroxide baths and gyms either worn as jewelry or placed around the home in special places. Instead of proven treatments for high blood pressure, hyperlipidemia, and atherosclerosis, it recommends unproven herbs and chelation. For acute stroke, it recommends ice cold compresses over the carotid arteries, plus subtle energy medicine. AIDS is mentioned in the textbook. It recommends naturopathic treatments even though it admits there are no clinical studies showing that they work. It gives no information about the conventional treatment of AIDS with antiretroviral drugs, for which there are clinical studies showing that they're life-saving. Patients with HIV infection will not progress to AIDS and will have a near-normal life expectancy if they're treated with HAART, highly active antiretroviral drugs. Naturopathy students are not taught about those effective drugs, and yet they're treating patients who have HIV. There is an AIDS Research Center at the premier naturopathic school best year. Here's what they recommend for treating AIDS. St. John's wort and garlic, both of which happen to interfere with antiretroviral drugs. Acupuncture detoxification oricular program, whole-body hyperthermia, adrenal glandular, homeopathy, cranioelectrical stimulation, digestive enzymes, colloidal silver, and nearly 100 more dubious remedies. All of this is quackery, and they don't recommend the antiretroviral drugs. Naturopathy students may be taught a lot about science, but they're also taught that homeopathy is valid, that dissolved oxygen can be absorbed through the skin in appreciable quantities, that sugar in the diet translates to sugar in the ear, that golden seal cures streptococcal pharyngitis, that wet compresses can abort an evolving stroke, that swallowed whole enzymes somehow escape digestion and home in on arthritic joints, that the iris contains a homunculus, a representation of the whole body that is the key to diagnosis of disorders throughout the body, and that craniosacral rhythms exist and can be manipulated to improve health. In 2011, a Canadian group reviewed websites of naturopathic clinics to see if what they offered was science-based. The answer was a resounding no. Most clinics advertised quack treatments like homeopathy, detoxification, hydrotherapy, and chelation, and they offered quack tests like electrodermal testing, live blood cell analysis, hair analysis, and so on. The reviewers concluded what they advertised as their core services paints a picture of a profession that has embraced practices that are remarkably unscientific. Despite this reality, many claim that their services are evidence-based and scientific. Naturopathy claims to use natural treatments, but how natural are these? Supplement pills, IV infusions, minor surgery, homeopathy, electromagnetic and mechanical devices, acupuncture? Here are the basic principles of naturopathy. First, do no harm. Physician is teacher. Treat the whole person. Prevention. The healing power of nature. And treat the cause. Naturopathy can hardly claim to own these principles. They're just the same principles of good medicine that we were all taught in medical school. One, first do no harm. Primum known nocari. That's been a foundational principle of all medicine since the ancient Greeks. Naturopaths seem to interpret this as don't give drugs because they might have side effects. That's not what it means. It means that we should make sure our treatments don't do more harm than good. And of course that's exactly what doctors do. We look at the risk-benefit ratio for every treatment, and we only use a treatment when we're convinced that the benefits outweigh the risks. And naturopaths don't really apply this principle. Many of their treatments have never been proven to work, and they've never been tested for safety. Some of the things they do have been tested and have been proven to cause some degree of harm without providing any benefit. To me, first do no harm means don't use untested treatments because without testing, you have no way of knowing that they won't do more harm than good. Two, physician is teacher. Physicians have always been teachers. The very word doctor is derived from the Latin word for teacher. Doctors have expert knowledge that they share with patients. They teach patients about their illness and about how to stay healthy. Naturopaths teach patients things that are not true. They share beliefs about things that aren't based in reality. And they teach that certain things have been proven effective when they haven't. Three, treat the whole person. That's exactly what we're taught in medical school. To look at the patient not as a body with a disease, but as an individual person with a history, a psychology, belief systems, a family, a job, a lifestyle, finances, an environment, and so on. The standard medical history form includes a section for social history that reminds the doctor to consider everything about the patient that might have an impact on health from psychology and lifestyle to family and finances. In a sense, naturopaths really don't look at everything about a person because they neglect some of the basic aspects of scientific knowledge about the patient's physiology and biochemistry. Four, prevention. Doctors would always rather prevent a disease than treat it. Conventional doctors invented prevention and they've always told that prevention is the best cure. They've always emphasized vaccines and screening tests, advice about diet, exercise, alcohol, tobacco, et cetera. And naturopaths don't practice what they preach. Their patients are less likely to get effective prevention measures like vaccines and screening tests. And they're more likely to catch vaccine-preventable communicable diseases. Naturopaths certainly haven't demonstrated that what they do is effective in preventing disease. Here's an example of what passes for preventive medicine in the world of naturopathy. When a patient asked a professor at Bastier, so what can I do to lower my risk of getting breast cancer? He answered, Keep your breasts happy and healthy. Love them and yourself. We often develop illnesses because of our own unresolved feelings and lack of love for ourselves. Deal with any unresolved maternal, nurturing and relationship issues so they're not lurking in your breasts. That's not only nonsense, but it amounts to emotional blackmail to blaming the victim. Five, the healing power of nature. Treatments don't heal the body. The body heals itself. And MDs have always known that. Antibiotics aren't meant to heal the lungs and pneumonia. They're meant to kill the bacteria so the lungs can heal themselves. Science-based treatments facilitate known physiologic healing processes by rational means. Naturopaths try to facilitate a mythical vitalistic healing force, the vis-medicatrix naturi, by irrational means. And they can't even begin to explain the mechanism by which their treatments might work. Six, treat the cause. They say, MDs just treat symptoms. We treat the underlying cause. Wrong. This stupid mantra is a vile false accusation that we hear all the time from alternative medicine sources. Doctors treat the underlying cause whenever possible. They don't just treat symptoms and give painkillers for appendicitis and cough syrup for pneumonia. Naturopaths fool themselves into thinking that they're treating underlying causes when they're really only treating symptoms. The people who accuse doctors of not treating the underlying cause are often the ones who think all disease is due to one bogus underlying cause, like subluxations or disturbances of chi or poor diet. Medicine recognizes all these real underlying causes of disease. I showed this list before in lecture two. I won't go over it again. Naturopaths invoke a few simplistic, unproven and often fanciful causes. They include toxins, which to them means most pharmaceuticals, widespread food allergies, dietary sugar, fat and gluten, inadequate vitamin and mineral intake, epidemic candidiasis, yeast infection, vertebral misalignment, intestinal dysbiosis and imbalances of chi. Naturopaths seem to think that all of these cause disease by interfering with the vis-medicatrix naturae. How would they know? By what mechanisms could they interfere with it? How could naturopathic remedies remove that interference? Most of these causes are nothing but fairy tales. Naturopathy can kill. I'm going to tell you three very sad stories. Little Lori Atikian died when she was only 17 months old. She had been perfectly healthy up until the age of 9 months. When she died 8 months later, she was nearly bald, covered with deep red rashes so emaciated that paramedics thought they were being tricked by being given a doll to treat. A naturopath had been treating her with royal jelly, herbal concoctions and an electric vitalizing machine. When her hair fell out, he told her parents it was normal. He told them not to worry if she didn't gain weight and not to take her to the hospital because it would be like holding a loaded gun to her head and pulling the trigger. The day before she died, the naturopath told her mother to wrap her in cabbage leaves to draw out the poisons. Her parents were sentenced to two years in jail. Incredibly, the naturopath was not charged. A teenage girl had asthma. The naturopath treated her with acupuncture, vitamin B12 and herbal tinctures. She failed to do the necessary pulmonary function test to assess the severity of the girl's condition. The girl died of an acute asthma attack. A breast cancer patient died after treatment with herbal remedies, including pesticide removal tinctures. The naturopath blamed the patient for giving up. These patients were harmed but not killed. Raj Bajitha was a 69-year-old man who developed circulatory failure in both of his legs. The naturopath failed to recognize the emergency and continued to treat him with massage and a supplement. Raj Bajitha had to be amputated. Ruth Conrad had a bump on her nose. The naturopath told her it was cancer. He treated her with a black salve, also called canesema, a thick paste that destroys tissue. When her face became painful and red streaks started running down her cheeks, he explained that the lines were a good sign because they resemble a crab and cancer is a crab. The naturopath was a big, a large part of her face sloughed off. It took three years and 17 plastic surgeries to reconstruct her face. Here's what naturopaths do that is different from what science-based medicine does. They spend more time with patients. They show a real interest in them as persons and they ask about all aspects of their life. They use unproven treatments and pretend they have proof. They use unproven and fantastical treatments. They disregard science in favor of anecdotes. In fact, many of them see evidence-based medicine as an ideological assault on their belief and vileistic and holistic principles. They try all kinds of combinations of remedies without any rationale for doing so. They can't take care of patients who are really sick and need to be hospitalized. They don't have the knowledge and experience to recognize an emergency. In a survey when they were asked about a two-week-old infant with a fever, only 40% of naturopaths said they would send her to the emergency room. The rest didn't know that a fever in a child at age is a medical emergency that requires immediate hospitalization. The one good thing on this list is spending more time with patients and good science-based clinicians want to do that and they can make a lot better use of the time. Naturopaths love to engage in the sport of doctor bashing. They seem to think that if they can prove medical doctors are bad, that will prove that naturopaths are good. That doesn't follow. It's a failure of logic called the tukwokwe fallacy. They say that scientific medicine doesn't have all the answers. Well, of course science doesn't have all the answers, but it's looking for answers with scientific research and where science doesn't have an answer, naturopathy doesn't either. They say conventional medicine is dangerous and sometimes it is. Treatments that have effects have side effects. We consider the risk-benefit ratio and it's usually more dangerous not to treat. They say that only 15% of conventional medicine is evidence-based and that's not true. 76% of what doctors do is supported by some form of compelling evidence. 37% is supported by gold standard randomized control trials. Steven Novella, who is an academic neurologist, has estimated that 99% of what he does is either supported by studies or by rational guesses based on good scientific principles. And as I said before, the 15% is based on a misunderstanding of an old study that has been thoroughly debunked. There's a link to the article that debunks the myth in the course guide. In integrative medicine clinics, sometimes naturopaths work alongside medical doctors. I think this is in direct violation of the AMA Code of Ethics, which says it is unethical to engage in or to aid in a bet in treatment which has no scientific basis and is dangerous, is calculated to deceive the patient by giving false hope or which may cause the patient to delay seeking proper care. Here are some of the reasons patients find naturopathy attractive. Natural sounds good. Naturopathy offers hope, simple explanations and answers. Unfortunately, these are usually false hopes, imaginary explanations and wrong answers. They may have had a bad experience with medical doctors. They may be afraid of the side effects of drugs. Naturopaths spend more time with patients. Patients may want diet and lifestyle advice. They may be influenced by new age fads and it may cost less. But paying less for a treatment that doesn't work is false economy. Not treating at all would cost even less than naturopathic treatment and it might be just as effective and it might have fewer side effects. Licensing boards were established to protect the public by ensuring that practitioners are qualified. But that doesn't always work. There was a scandal surrounding the Arizona naturopathy board exam. Initially, none of the 18 applicants scored the necessary 75%. So they kept adjusting scores upward and eliminating questions to let the candidates pass. The board gave full credit for about one-sixth of the questions that they decided were too difficult. One applicant got full credit for 90 incorrect answers. And of course, even the correct answers on these exams are likely to be incorrect by scientific medical standards. These two groups evaluated naturopathy and both of them recommended against licensing naturopaths. The Australian Committee of Inquiry found naturopathy very difficult to define and was unable to find any clear-cut statement capable of adequately describing the activities of this group of practitioners in such a way that any expectation of their behavior as consultants could be predicted by a patient. They found inadequate education, many quack diagnostic and therapeutic methods. The HEW report found that naturopathic theory and practice are not based on the body of basic knowledge related to health disease and health care which has been widely accepted by the scientific community. The scope and quality of naturopathic education do not prepare the practitioner to make an adequate diagnosis and provide appropriate treatment. Naturopaths rely heavily on natural herbal remedies. So let's look at herbal remedies. Here's a short history of medicine. 2000 BC. Here, eat this root. 1000 AD. That root is heathen. Here, say this prayer. 1850 AD. That prayer is superstition. Here, drink this potion. 1920 AD. That potion is snake oil. Here, swallow this pill. 1965 AD. That pill is ineffective. Here, take this antibiotic. In 2000 AD. That antibiotic is artificial. Here, eat this root. It seems we've come full circle. Are herbal drugs better than prescription drugs? Here are the four arguments I usually hear. Herbs are natural. Everybody just knows that natural is better. People subscribe to the natural fallacy where natural is equated to good. They forget that nature makes poisons that kill people. Nature is not user-friendly. Plants don't produce chemicals to cure the illnesses of humans. They produce chemicals to keep animals from eating them. Sometimes we get lucky and those chemicals happen to have medicinal effects. I've had people tell me that a molecule made by a plant is somehow better than if it's made in a lab. It isn't better, it's the exact same molecule. Synergism. They claim that plants have lots of other ingredients that enhance the effect of the main ingredient. There's very little evidence for that. Other components are just as likely to decrease the effectiveness and to add unwanted side effects. When an herbal medicine has been compared to its active ingredient alone, the active ingredient almost always works as well or better than the mixture. Natural remedies are milder. Well, some herbs are milder than some drugs. Some drugs are milder than some herbs. Some herbs are the same as drugs. And it depends on the dose. Natural remedies don't have side effects. Well, yes, they do. They may seem to have fewer side effects only because no one has systematically looked for side effects. There's the ancient wisdom fallacy. They'll tell you an herb must be safe because it's been used for centuries. But side effects could easily be missed. Remember thalidomide? For several years, they thought thalidomide had no side effects and then they'd belatedly made the connection with birth defects. Now, that kind of connection would not have been noticed by ancient herb doctors who only saw a few patients and didn't have modern means of communication or gathering statistical information. If you think herbal medicines are milder, let me tell you about the ephedra plant, also known as mahuang. It's been banned in the U.S., but you can still buy it online. It has these three active ingredients, ephedrine, pseudo-ephedrine, and phenylpropanolamine. Ephedrine is a prescription drug that is only approved for injection. Pseudo-ephedrine is pseudo-fed. It's been banned by the International Olympic Committee. Phenylpropanolamine, or PPA, is a drug that was once sold over the counter. It's no longer available in the U.S. and it's been banned in many other countries because it can cause strokes. So, ephedra is not milder than these pharmaceuticals. It is these pharmaceuticals with some other stuff thrown in. The effect depends not on whether you're getting it in the form of an herb or a pharmaceutical, but on how much active ingredient you're getting. Herbs are certainly milder when you're getting a lower dose and they may be stronger if you're getting more than you think. This pretty flower is a foxglove. It grows wild in the forests of the Pacific Northwest where I live. The whole plant is toxic. It causes dizziness, vomiting, irregular heartbeat, and hallucinations or delirium and it can kill you. If you give a small dose of foxglove leaf, you can avoid the toxic effects but it was hard to know how much to use because the strength can vary with the soil the plant grows in, the time of the year the leaf is collected, or the way the extract is produced. Pharmacology came to the rescue. Scientists isolated the active ingredients and learned their exact chemical structure and then they improved on it. Synthetic derivatives like digoxin work better than foxglove leaf and were safer. The dosage is critical with foxglove because the therapeutic dose is dangerously close to the lethal dose. With prescription digoxin we can measure the blood level of the drug and we can treat an overdose with a specific antidote. We couldn't do that with an herbal formulation. So you've got to ask why would anyone want to give up artificial digoxin and go back to natural foxglove leaf? My colleague David Gorski says herbs when they work are adulterated drugs. Which herbal medicines work? Well, some of them are untested or inadequately tested. Some have been tested and found not to work but are still used anyway. Some have been tested and found to work but even those are not usually the best choice. The manufacturers and sellers of natural medicines don't give you much information. They don't provide package inserts and the information on the labels is pretty skimpy. But the information is available if you know where to look. This is the source I rely on the Natural Medicine's comprehensive database. I think of it as the Bible for information about natural medicines. It's published by disinterested parties in its complete and non-judgmental. It tells you everything. Other names for the same drug. What people have used it for. The safety rating. Effectiveness rating. Mechanism of action. Adverse reactions. Interactions with herbs and other dietary supplements. Interactions with drugs. Interactions with foods. Interactions with lab tests. Interactions with diseases or other conditions. Dosage and administration. Comments. And it also lists references for all the books and published studies that it relied on for the information. It's a great resource but unfortunately both the book and the online subscription are rather expensive. And the average consumer doesn't have access to this kind of information. I wondered what the chances are that a random natural medicine is safe. So I went through the book and I tabulated the ratings. Now remember they're rating the safety of the pure medicine in an appropriate dose. And when you buy an herbal medicine tea that you're getting a pure product or that the dose on the label is accurate. They rated 38% as likely safe. 25% as probably safe. 6% as possibly unsafe. 8% as likely unsafe. 4% as unsafe. But here's the scary thing. There was insufficient information to rate the safety of 21% of them. So taking one of those medicines is a bit of a crapshoot. This is the tabulation of effectiveness ratings. 5% were rated as effective. 6% as likely effective. 26% as possibly effective. 2% as possibly ineffective. And less than 1% as ineffective. There was insufficient information to even provide a rating for a whopping 60% of natural medicines. Will further studies show that more of these products are effective and safe? Probably not very many of them. Keep in mind that only a small percentage of promising pharmaceutical drugs that make it to the clinical trial stage ever make it to the market. Very few are rated both safe and effective. And almost all of those are vitamins and minerals that are also available as prescription or over-the-counter medicines approved by the FDA. Our naturopaths experts in natural remedies. Dr. Kimball Atwood chose 13 natural remedies at random. And he compared what the major naturopathy textbook said about them to what the natural medicines comprehensive database said. Only a few agents recommended by the naturopathy textbook were rated by the NMCD as possibly effective. Some were rated as likely ineffective. And the vast majority were rated as insufficient reliable information to rate. For example, vitamin C was recommended for 100 indications in the textbook but was rated as possibly effective for only one of those indications in the NMCD. Naturopathy textbooks accept animal and test tube studies and they minimize the dangers and safety concerns. The real danger lies in replacing conventional treatments with unproven remedies. Here are some of the possible disadvantages of herbal medicines. They contain unwanted components. In addition to the active ingredient, they contain other chemicals that may provide no benefit and may cause unwanted side effects. The information is incomplete. You don't get any warnings of side effects and drug interactions. There are no package inserts like pharmaceuticals. It's difficult to control the dose. Herbs in their natural state vary from batch to batch. Contaminants. Herbal remedies have been found to contain poisons, cancer-causing chemicals, insect parts, and even prescription drugs. 20% of the Ayurvedic remedies that were sold in Boston stores were found to be contaminated with toxic levels of heavy metals. The content may not correspond to the label. In a recent study only 41% were accurately labeled. Independent lab analyses have shown that the amount of active ingredient varied by as much as a factor of 10. Some contain no active ingredient at all and some contain several times as much as the label said. Ineffective regulation. Diet supplements don't have to meet the same standards as prescription drugs. Regulators don't do a good job of stopping illegal claims. When they evaluated 443 websites they found that 81% of them made illegal health claims. 55% illegally claimed to treat, prevent, diagnose, or cure specific diseases. And 52% omitted the legally required standard FDA disclaimers. Inadequate monitoring. Prescription drugs are systematically monitored for complications and side effects. Natural medicines aren't. And we know that 12% of herbal remedy users have adverse effects. Interactions. Something as benign as taking too much vitamin C can make birth control pills fail. Ginkgo can cause bleeding problems when used with other medications and it should be stopped before surgery. Herbs are effective. In most cases there is a pharmaceutical that is more effective. A recent study looked at what was in herbal medicines using DNA analysis. They evaluated 44 products from 12 companies. They found that only 48% contained the authentic product. 59% complained plant species that were not listed on the label. 1 third of them contained substituted ingredients. And none of the labeled ingredient. One sample was labeled as containing St. John's wort used to treat depression. But it actually only contained senna, a laxative. So instead of lifting your mood it would put you on the toilet. Steven Novella says I am not a fan of herbal medicine. Herbs are drugs. Herbal products on the market are simply poorly regulated drugs that probably don't work, that have variable doses, often have contaminants and may be incorrectly labeled. So they are terrible drugs. They are sort of like street drugs. You can never be sure what you are buying. The story of red yeast rice is really ironic. It has been promoted as a natural alternative to statin drugs for lowering cholesterol. And it works. Sure it does because it contains the exact same active ingredient, lovestatin that's in prescription drugs. It isn't an alternative to statins. It is a statin. Only in a form that is not as pure or as well regulated as the prescription forms. Oops! It was lovestatin but it's not anymore. Because the FDA now requires that the drug lovestatin be removed from red yeast rice before it can be sold in the U.S. as a diet supplement. Stephen Barrett of Quackwatch says I believe that the average naturopath is a muddlehead who combines common sense health and nutrition measures and rational use of a few herbs with a huge variety of unscientific practices and anti-medical double talk. Here's my conclusion. The things that naturopaths do that are good are not special. And the things they do that are special are not good. Their only claim to fame is spending more time with the patient. If science based doctors could find a way to spend more time with patients they could put that time to much better use than naturopaths do. In the next lecture I'll talk about another form of CAM, energy medicine.