Herbal Remedies & Political Comedy.

You’ve seen them before. Those white bottles with nature themed labels claiming anything from weight-loss to anti-aging. You found them tucked away in the medicine section that one time you went to Whole Foods only to find out you still can afford nothing there and settled for that shady oriental super market down the street.  You know, the one with the cranky cashier who still can’t pronounce “alfalfa”.  They are herbal remedies and plant extracts, and they have been a target of constant scrutiny ever since that one friend of yours told you they swear by it and you were tempted to commit in the same fashion.

Actually… I think that’s your friend’s mom right there

Of course, the temptation is palpable.  With the overarching trend of everything having to be completely natural, it was only organic to assume that our medicine had to follow along.  This, coupled with our innate distrust of Pharmaceutical companies, fuels the demand for alternative medicines and their proposed cures.  The attention that these alternative medicines were receiving became so great that even federal bodies such as the European Medicines Agency and the FDA finally recognized the informal name of the active compounds in these products, Adaptogens.

With an increasing market presence, and pros and cons thrown about with the care of your first paycheck, I look into what these adaptogens really are, whether they work, and why it’s so hard to cement legitimacy behind those super pricey pills of ground up roots.

What the heck are they?

Dr. Alexander Panossian is the head of R&D at the Swedish Herbal Institute.  With 93 publications on adaptogens alone, it feels only right to use his definition for the term.  He states “Plant adaptogens are compounds that increase the ability of an organism to adapt to environmental factors and to avoid damage from such factors.”  Essentially, they can be any plant compound that protects you from disease or bodily harm, or lowers your risk of disease or bodily harm.

There are many popular examples that you’ve likely encountered before,  probably through that one friend in your group obsessed with health or one of the many blogs that focus specifically upon this topic.  No. Seriously.  I Google’d “adaptogen” and half of the first search page are just blogs.  Which goes to show two things.  Either there is a healthy population out there that believes wholeheartedly in this treatment, or there are a lot of bored parents whose children just introduced them to blogging so they’d stop adding them on Facebook.

There are two, choose one and don’t add me on either, Dad.

Ginseng, Echinacea, and even licorice root are all examples of plants where we derive adaptogens.  You can see their claims of being a stress reliever, or even an immunostimulant all over scientific and pop culture literature.  Yet, at the same time, why is it that these substances are still viewed with a lens of scrutiny?  I think this quote sets the tone best for out next section: “There is, however, a lack of independent replications of the single different studies.”

Why are they tough to figure out?

Let me set up an analogy.  Imagine if you will, a scenario where you have an adorable litter of kittens.   Each of them are roughly the same in almost every aspect.  Not one is cuter, nor more cuddly than the other.  You seek to find out whether or not the kittens like to scratch your favorite table.  Normally in a proper research environment, you’d find someone who is immune to the kittens’ charm to prevent bias, have him or her conduct a study in an environment similar to your home with the kitten next to the table to see if it scratches it, and if so, how many times.   You take each kitten and put it through the same exact test, and come up with results that you stick through a statistical test to see if they have the tendency to scratch your prized table.

“I f*ing love this table*

The state of adaptogenic research would be the equivalent of five different researchers taking your kittens, sticking them in an environment other than your home, and checking to see if it scratches anything.  Not even your favorite table, but anything in a house.   Notice how this doesn’t really answer the question you set out to solve?  That’s pretty much how it is.  The crux of this issue is of course, consistency.

Replication of an experiment to produce similar results is one of the core tenants of appropriate research design.   It is what separates fact from fiction, as it proves that if you set things up correctly, a phenomenon will occur exactly as planned.   Much like Taylor Swift hit singles, experimental methodology should be just as accurate upon every single playback, and just as enjoyable to a scientist’s ears as T-$wift is to mine.  You simply cannot call something good science without it.

With the marketing potential behind adaptogens, and the herbal supplement/remedy market rounding out close to 100 billion USD as an industry, its not hard to see why there is so much conflicting science.  Let’s look at ginseng.  There is an entire scientific journal dedicated to ginseng research alone run by an entire society dedicated to the promotion of ginseng.  These are mostly Asian scientists, due to the high demand of the product in oriental countries, and of course they want to see its medicinal potential given its cultural entrenchment.

Korean red ginseng. Grown in America. Shipped to China. Bought by Europeans. Supply chains never had to make any real sense.

Western scientists however are more prone to giving things a hard second look.  One only has to search around to see pages citing how ginseng studies fail to produce truly significant results.  There are even counter articles in place to remind consumers to be wary of health claims.  So what gives?  Why are there conflicting results, and why the heck is this issue as transparent as Hilary Clinton’s email history?  As muddy as Bernie Sander’s handling of black activists?  As flip floppy as Trump’s views on the Mexican demographic?

What prevents this?

If you’re a pharmaceutical company and you wish to release a new drug or medicine, it would cost you something to the tune of $2.6 billion US dollars.  That number isn’t entirely accurate and is at the center of dispute, but it’s pretty much agreed upon that making medicine costs a load of cash.  Why?

Let’s first ignore the whole political/business aspect of drug production.  Sure, there are more efficient ways of finding patients and structuring clinical trials, but the heart of the problem is just the same.   The FDA does an excellent job detailing this process, but of course you’re here for my rhetoric right? …….right?

At least I can always count on you, Jake.

If you were a drug company, you would need to hire world class experts to make your drug in a lab that may involve months or years of trial and error.  This final product must go through 3 phases of clinical trials, but before that it must go through animal trials to find the dosage that doesn’t kill us humans.  You nail the dosage in the first clinical trial, then expand the patient population for the second and third trials before its release.  All along the way, you, as the pharmaceutical company, must hire doctors, nurses, patients, and hospitals to work for you to bring these trials to fruition.  Last I checked hiring doctors ain’t cheap.

You see, that 2.6 billion dollar figure is already 1/40th of the ENTIRE herbal remedy industry.  With such high standards for quality drug production, you can imagine why even the most studied adaptogen, ginseng, still faces scientific scrutiny.  “Conflicting and unclear evidence” as they say.   The study design is only part of the problem too.   These plants have a load of side chemicals that are mixed in with their extracts making it difficult to truly ascertain their full effects.  With people unconditionally throwing money at these products, honestly, who cares.   Bad press simply doesn’t trump the desperation of a human being seeking a cure for an ailment.

So despite this being a political, economic, and scientific conundrum, the heart of the role of adaptogens, and other herbal remedies for that matter, is actually surprisingly ethical.

What can be done?

Daniel Callahan is Director of the International Program at the Hastings Center and Senior Fellow at the Harvard Medical School, and one of the finest American bioethists.  He’s the kind of guy who looks at rappers like Kanye and Jay Z stacking platinum records and chuckles as he stacks his pile of Ivy League degrees and publications.  Not really, but that’s what I’d do in his position.

More importantly, in his novel “What Price Better Health?” (which is a title so badass it doesn’t even need a verb) he discusses the cost of our modern research imperative.

What is the research imperative?   Basically, it is our ethical guiding post for how we fund science as a nation.   Each decade comes with its own trials.  The 50’s was about genetic splicing, 70’s had stem cell research, the 80’s dealt with cloning, and so on.   The point is, at every turning point in medical history, we as a species had to deal with what we felt is ethical, and how to best accept the merits of newer, more controversial science.  When you start a war against something like cancer, testing chemo treatments on animals seems like petty change compared to letting millions die without any effort to eradicate the disease.

However, one thing remains consistent as Callahan points out (I’d say its in the 2nd chapter, but I can’t cite this properly without my copy of the book).  We have placed increasing emphasis and value on human life.  A classic example, best portrayed in Star Trek, would be whether or not sacrificing the life of a single human is worth the price in exchange for saving many others.

I always tell me not to *sniff* cry at this.

If we’re talking pure economics, our lives are worth about 9 million dollars, but in reality, we’ve started to be less comfortable with risks.  That’s why drug trials are so expensive and always draw huge publicity. We place human life on a pedestal, yet try to make money at the same time.

A large facet of what made herbal remedies so attractive in the first place, is their historic use.  There isn’t a statistic published about this but I can almost guarantee that for every useful herb we have in our arsenal, there were 5 bad ones that killed off a couple of us.   Herbal medicine and their use is ironically both the antithesis of modern science, yet the purest application of the scientific method.  It doesn’t respect proper research methodology, yet its a simple exercise of observation with trial and error.

So what is to be done about this? The next step really is up to the public to parse out bad information.  To not be susceptible to marketing techniques and to be scientists themselves.  Does a remedy work for you?  Be honest about it and share it.  Is it a quack remedy?  Take your metaphoric pitchfork and raise some social media hell.  The scientists here are also at fault and thus the science will take a little to catch up, but sometimes its up to the consumers to take on a little bit of the risk and contribute as well.

In pursuing the safety of patients, we as a scientifically inclined species lost this basic tenant of accepting failure and finding value in knowing that we did something wrong.   Sure, adaptogenic research is shoddy, and sure, the scientists could be less biased and do a better job at planning experiments.  However, these are risks that could yield extraordinary benefit.  Marketing aside, there is merit behind some of these adaptogens.  Why else would they be used by countless of our kind over centuries?   Because when we got sick, that one dude who ate the plant and felt better told others to do the same.  Observation to results.  Science.

or…..just observation

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