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Authors: Simon Singh,Edzard Ernst M.D.

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Tuff found a variety of homeopaths by searching on the internet, just as any young student might do. She then visited or phoned ten of them, mainly based in and around London. Some of these homeopaths ran their own clinics, some were based at homeopathic pharmacies and one was based in a major mainstream pharmacy. In each case, Tuff secretly recorded the conversations in order to document the consultation.

The results were shocking. Seven out of the ten homeopaths failed to ask about the patient’s medical background and also failed to offer any general advice about bite prevention. Worse still, ten out of ten homeopaths were willing to advise homeopathic protection against malaria instead of conventional treatment, which would have put our pretend traveller’s life at risk.

The homeopathic remedies differed between homeopaths. Some offered Malaria nosode (based on rotting vegetation), while others recommended China officinalis (based on quinine) or Natrum muriaticum (based on salt). In every case, the remedies were so diluted than none of them contained any active ingredient and all were equally useless.

The homeopaths offered anecdotes to show that homeopathy is effective. According to one practitioner, ‘Once somebody told me she went to Africa to work and she said the people who took malaria tablets got malaria, although it was probably a different subversive type not the full blown, but the people who took homeopathics didn’t. They didn’t get ill at all.’ She also advised that homeopathy could protect against yellow fever, dysentery and typhoid. Another homeopath tried to explain the mechanism behind the remedies: ‘The remedies should lower your susceptibility; because what they do is they make it so your energy – your living energy – doesn’t have a kind of malaria-shaped hole in it. The malarial mosquitoes won’t come along and fill that in. The remedies sort it out.’

A few days later the BBC programme
Newsnight
conducted undercover filming at some of the same homeopathic clinics and found exactly the same empty remedies being offered to protect against malaria. It was in the run-up to the summer holiday season, so this became part of a campaign to warn travellers against the very real dangers of relying on homeopathy to protect against tropical diseases. One case reported in the
British Medical Journal
described how a woman had relied on homeopathy during a trip to Togo in West Africa, which resulted in a serious bout of malaria. This meant she had to endure two months of intensive care for multiple organ system failure.

The main point of the investigation into the homeopathic treatment of malaria was to demonstrate without doubt that even the most benign alternative medicine can become dangerous if the therapist who administers it advises a patient not to follow an effective conventional medical treatment.

It is likely that some of the alternative therapists who sell useless remedies for dangerous conditions are fully aware of what they are doing and are happy to profit from it. Before ending this chapter, however, it is important to stress that the majority of alternative therapists are acting with the best of intentions. These misguided therapists are simply deluding themselves, as well as their patients.

One of the most poignant examples of a well-intentioned homeopath is the case of an English homeopath working in Devon, whose identity cannot be revealed. In 2003, she noticed a brown spot on her own arm, which was growing in size and changing in colour. At the time, she was in regular contact with doctors as she was taking part in a study organized by Professor Ernst, which was designed to see if homeopaths could treat asthma. Rather than discussing her lesion with the doctors, however, she decided to treat it herself using her own homeopathic remedies.

She had such faith in her remedies that she treated the spot for several months and continued to keep it a secret from the doctors. Unfortunately, the spot turned out to be a malignant melanoma. As each month passed, the chance for early treatment of this aggressive form of cancer steadily disappeared. While she was still in the middle of treating asthma patients, the homeopath died. Had she sought conventional treatment at an early stage, then there might have been a 90 per cent chance that she would have survived for five or more years. By relying on homeopathy, she had condemned herself to an inevitably early death.

5 The Truth About Herbal Medicine
 

‘The art of healing comes from nature and not from the physician. Therefore, the physician must start from nature with an open mind.’

Paracelsus (1493–1541)

 

Herbal Medicine

The use of plants and plant extracts in the treatment and prevention of a whole range of diseases. Herbal medicine is one of the oldest and most widespread forms of treatment. Based on local plants and traditions, it continues to play a major role in healthcare in Asia and Africa. In recent decades, herbal medicine, sometimes known as phytotherapy, has become one of the fastest-growing forms of treatment in the rest of the world.

 

T
HE FIRST CASE OF ALTERNATIVE MEDICINE DISCUSSED IN THIS BOOK
concerned Ötzi, the 5,000-year-old mountain hiker whose frozen body was found in Austria in 1991 with various tattoo marks. These tattoos were located at points that are still familiar to modern acupuncturists, so it seems possible or even likely that Ötzi had been receiving a treatment akin to acupuncture. There is additional evidence, however, that Ötzi was also receiving another form of alternative medicine, namely herbal medicine.

Archaeologists studying Ötzi’s body found two walnut-sized lumps threaded together on a leather thong. The lumps were identified as the fruit of the birch fungus (
Piptoporus betulinus
), which contains polyporenic acid, which acts as an antibiotic. This discovery became particularly interesting when scientists discovered that Ötzi’s colon was infected with the eggs of a parasitic whipworm known as
Trichuris trichiura
, which can be killed by polyporenic acid. Writing in the
Lancet
, an anthropologist named Dr Luigi Capasso concluded: ‘The discovery of the fungus suggests that the Iceman was aware of his intestinal parasites and fought them with measured doses of
Piptoporus betulinus
.’

From Ötzi’s fungal medication and similar archaeological evidence, we know that mankind’s most ancient system of medicine was based on plants. Of course, our ancestors would have had no idea that
Piptoporus betulinus
contained polyporenic acid and that this killed the eggs of
Trichuris trichiura
, but they knew enough to realize that consuming birch fungus somehow alleviated certain types of stomach pains, and similarly they worked out that other plants somehow cured other conditions.

Societies around the world used trial and error to develop their own bodies of medical knowledge based on local plants, with the tribal healer acting as the expert database and provider of medicines. Each generation of sangomas and shamans gradually accumulated further information about the natural remedies that grew around them, so that herbal medicine became an increasingly powerful system of health-care. Then, in the eighteenth century, herbal medicine suddenly entered a new era when it started to be investigated by scientists who sought to improve on nature’s medicine cabinet.

In 1775 a British physician called William Withering joined the staff at Birmingham General Hospital and shortly thereafter he became a regular attendee at the Lunar Society. The Lunatics were a group of eminent men who met once a month on the Monday closest to the full moon – this allowed them to discuss science late into the night and still have some illumination on their journey home. Withering’s career in medicine combined with his interest in science resulted in a major investigation into the medical benefits of the foxglove plant, also called
digitalis
. It had long been known that digitalis could be used to treat dropsy, a swelling associated with congestive heart failure, but Withering spent nine years meticulously documenting its impact on a total of 156 patients. In his experiments, he varied how the digitalis was prepared and also altered the dosages in order to learn how to maximize the herb’s benefits and minimize its side-effects. For example, he learned that the dried powdered leaf was five times more effective than a fresh foxglove leaf; that boiling the leaf weakened its impact on the patient; and that excessive use of the plant would lead to nausea, vomiting, diarrhoea and a tendency to see the world with a yellow-green tinge.

He published his research in 1785 in a book entitled
An Account of the Foxglove and Some of its Medical Uses
. His report highlighted his rigorous and impartial approach to analysing digitalis:

It would have been an easy task to have given select cases, whose successful treatment would have spoken strongly in favour of the medicine, and perhaps been flattering to my own reputation. But Truth and Science would condemn the procedure. I have therefore mentioned every case…proper or improper, successful or otherwise.

 

Withering’s research marks a turning point in the history of herbal medicine, from its haphazard ancient roots towards a more systematic and scientific attitude. One by one, traditional herbs were submitted to scrutiny. A good illustration of this new rational approach is the way that scientists harnessed the potential of cinchona tree bark, which had long been used by the Peruvian Indians to treat malaria. Jesuit priests learned of its curative powers in the 1620s, and within a couple of decades the so-called Jesuit’s Bark was highly valued in large parts of Europe. Indeed, the seventeenth-century Italian doctor Sebastiano Bado considered cinchona bark to be a more valuable treasure than all the gold that had been brought back from South America.

Herbalists prepared the cinchona bark for medical use by simply drying it and then grinding it into a fine powder. It was this powder that inspired Samuel Hahnemann to invent homeopathy, as discussed in Chapter 3. Scientists, however, took the herbal remedy in quite a different direction and ultimately maximized its potential. Speculating that it was only one component of the bark that was medically active, they attempted to isolate that component and then deliver it in a more concentrated and potent manner. It took until 1820 before two French chemists, Pierre-Joseph Pelletier and Joseph-Bienaimé Caventou, isolated a compound that they called
quinine
, based on the Inca word for the cinchona tree. Thereafter, scientists could properly study in detail the effects of this anti-malarial substance and optimize how it could be used to save lives.

Just a few years after quinine was isolated from cinchona bark, scientists focused their attention on willow bark, which had been used to reduce pain and fevers for thousands of years. Once again, they successfully identified the active ingredient, this time naming it
salicin
, based on
salix
, the Latin word for willow. In this case, however, chemists took nature’s drug and attempted to modify and improve it, driven by the knowledge that salicin was toxic. Taken in either its pure form or in willow bark, salicin was known to cause particularly harmful gastric problems, but chemists realized that they could largely remove this side-effect by transforming salicin into another closely related molecule known as acetylsalicylic acid. The Bayer Company in Germany started marketing this new wonder drug under the name of aspirin in 1899, and kicked off its promotional campaign by writing to 30,000 doctors across Europe in the first mass mailing in pharmaceutical history. Aspirin was an immediate success and there were numerous celebrity endorsements – Franz Kafka said to his fiancée that it eased the unbearable pain of being.

Thanks to the scientific approach, aspirin has gone from strength to strength. It is now the cheapest and biggest-selling drug in the world, and it has become far more than the painkiller it was first believed to be. Clinical trials have shown that it can reduce the risk of heart attack, stroke and many types of cancer. On the negative side, scientific investigations have also revealed that aspirin can lead to stomach bleeding in 3 out of every 1,000 people and can increase the risk of asthma attacks. Moreover, aspirin is not recommended for children under twelve years of age.

It is already becoming quite clear that this chapter on herbal medicine will be very different from the previous chapters on acupuncture, homeopathy and chiropractic manipulation. These other therapies have struggled to be accepted by mainstream medicine, partly because their underlying philosophies conflict with our scientific understanding of anatomy, physiology and pathology. Why should needling non-existent meridians improve hearing? Why should ultra-dilute homeopathic solutions devoid of any active ingredient treat hay fever? Why should manipulating the spine alleviate asthma? By contrast, plants contain a complex cocktail of pharmacologically active chemicals, so it is not surprising that some of them can impact on our wellbeing. Consequently, herbal medicine has been embraced by science to a far greater extent than the other treatments mentioned above.

Indeed, there is general agreement that much of modern pharmacology has evolved out of the herbal tradition. According to the neuroscientist Patrick Wall, 95 per cent of the painkillers used by today’s doctors are based on either opium or aspirin, and the range of modern drugs based on plants includes the anti-cancer agent taxol (from the Pacific yew tree) and the anti-malarial drug
artemisinin
(from the artemisia shrub). Some nature-based remedies have had very humble origins, such as
penicillin
, which was discovered when a speck of
penicillium
mould floated into a laboratory in Paddington, London. Other remedies had to be tracked down in more exotic locations, such as Madagascar, home to a species of the periwinkle that has yielded dozens of interesting chemicals, including the drugs
vincristine
and
vinblastine
used in chemotherapy.

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