I was fortunate enough to have dinner with a retired ENT professor the other
night. As all doctors do after being introduced, we began exploring each other’s
opinions on various aspects of medicine, and I was delighted to hear he was an
advocate of EBM, as I am.
Regular readers of this column will know that I have
mentioned the acronym EBM many times. This stands for “Evidence Based Medicine”
and is a key factor in modern medicine. It just means we test until we have the
evidence that any drug or treatment really does work. This all takes time, as
the evidence cannot just hang on one person who got better. It requires huge
series, across the globe (and even then we get a few wrong).
However, as patients, or sufferers of any complaint, we want
that “cure” right now! Consequently, with all medical conditions where we cannot
give the patient the “wonder pill” there is then a tendency for them to try
something else, anything else, hoping for the relief that conventional medicine
has not promised or delivered. For the musculo-skeletal conditions, for example,
the “alternatives” are multiple, from magnets to mussels from New Zealand. But
do they really work?
The problem with the non-pharmaceutical mainline pills and
potions industry is in unbiased scientific testing. The tablets that Roche,
Parke-Davis, Bayer and all that lot produce are rigorously and vigorously
(viagorously?) tested. Not only do the drug companies have to show that their
pills actually work, but they also have to show what side effects they can
produce and whether or not they interact with other pills and potions to make
explosive mixtures. The “alternative” pill and potion manufacturers do not have
the same degree of scientific scrutiny.
There are those who will claim that because the remedies come
from plants, that the ingredients are then “natural” and therefore OK for us
humans. This is pseudo-scientific nonsense. Extracts of plants and herbs are
chemicals - and some chemicals can kill, that is why wild animals can die after
eating the wrong plants. So can you!
So let us look at a few of the alternative treatments and
analyze just whether they are indeed efficacious. Willow Bark is one that is
used for arthritis, because it was imagined that since the tree grew in damp
environments, and arthritis was thought to be caused by “damp” then treatment
with the bark was “logical”. The herbalists got the right answer, however, no
matter how wrong the reasons! Willow Bark does have an effect because it
contains salicylates - more commonly known these days as aspirin! Other
“natural” sources of aspirin include poplar tree bark, black cohosh (a North
American plant), pansies, violets and meadowsweet. Aspirin works!
Have you heard of Devil’s Claw? This South African plant has
been studied to see if it has any anti-inflammatory action in arthritis. The
small studies that have been done show no effect, but it is an analgesic (pain
killer), so those people with arthritis do feel better when they take it. In
fact, demand is now outstripping supply - but they would do just as well with a
strip of paracetamol tablets. And cheaper too!
Another of the well touted treatments for arthritis is the
green lipped mussel. According to the pundits, this form of treatment has had
numerous clinical trials, and unfortunately, the same number of clinical
failures! However, I believe they are quite nice steamed with garlic, ginger and
One other niggling problem with the “natural” therapies is
that for musculo-skeletal problems, most of which are of a long standing chronic
nature, even less scientific work has been done to see what happens when you
take these medications for a protracted period of time. Until long term safety
has been ascertained, I would counsel caution, and beware mixing pharmaceutical
drugs and over the counter “alternatives”!
Reactions to pharmaceutical items are still reasonably rare
and well documented. I cannot say the same for the “natural” remedies.
Finally, I was very amused to read of a health food shop
being offered for sale. The reason the owner was prepared to sell? Ill health!