Prevention - If It's "natural," It Must Be Better, Or Every Man His Own Doctor

Probably the most common form of alternative medicine is the ingestion of dietary supplements. A dietary supplement, as defined by the U.S. Office of Dietary Supplements, "contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical." Dietary supplements have been around for a long time. The trends in the way of self-medicating are megadoses (remember Dr. Linus Pauling and Vitamin C?) and the growing use of medicinal herbs.

The American Medical Association reported that the market for herbal remedies was $1.13 billion in 1993. The chart shows growth in sales of herbal remedies between 1995 and 1999. Sales rose 121% between 1993 and 1995 (to $2.5 billion), then rose another 64% between 1995 and 1999 (to $4.5 billion).

Dietary supplements are big business ($15 billion a year, says the U.S. Health and Human Services Department), and herbal remedies are a rapidly growing component of it. A joint survey by Harvard's Kennedy School and National Public Radio estimated that in 1999, more than 50% of adult Americans looked favorably upon supplements and would continue to take them even if their doctor recommended otherwise.²

We see from the chart that the most explosive growth in herbal remedies was in the use of St. John's Wort, touted as a treatment for depression. When the media point out that prescription drug prices have skyrocketed and suggest that cynical drug manufacturers are passing off modified versions of existing drugs as new to protect patents and profits, is it any wonder people turn to herbal remedies? The treatment of clinical depression is a $44 billion a year business. A dose of St. John's Wort is far less expensive than a prescription pharmaceutical like Prozac (on which Americans spend over $1 billion a year.)³

This brings to mind the placebo effect. The Skeptic's Dictionary (http://skepdic.com/placebo.html) tells us:

The placebo effect is the measurable, observable, or felt improvement in health not attributable to treatment. This effect is believed by many people to be due to the placebo itself in some mysterious way. A placebo (Latin for "I shall please") is a medication or treatment believed by the administrator of the treatment to be inert or innocuous. Placebos may be sugar pills or starch pills.

The Skeptic's page then refers us to an article from the Washington Post reporting that "After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work. And so do sugar pills…. The new research may shed light on findings such as those from a trial last month that compared the herbal remedy St. John's wort against Zoloft. St. John's wort fully cured 24 percent of the depressed people who received it, and Zoloft cured 25 percent — but the placebo fully cured 32 percent."

An area of concern for health care practitioners is the potentially harmful side effects and interactions of herbal home remedies. The Dietary Supplement Health and Education Act of 1994 allows manufacturers of herbal products to make general claims about well-being and the effects of substances on bodily function without evaluation or approval by the FDA. The act made manufacturers responsible for ensuring that a dietary supplement is safe before it is marketed. Is this confidence-inspiring?

A little later, Congress also has put the Federal Government into the business by establishing the National Center for Complementary and Alternative Medicine (NCCAM) as one of the National Institutes of Health (October 1998). Among other things, NCCAM is conducting tests on — yes — St. John's Wort. More on this later in this chapter and in Chapter 5.

The General Accounting Office credits soaring sales of dietary supplements to the passage of the Dietary Supplement Health and Education Act but warns that "Some companies promote their products to senior citizens by using 'antiaging' or 'cure-all' claims for which there is little or no supporting scientific evidence of either safety or efficacy." But there may be no stopping an aging population from self-medicating. Health Care Manager reports a 130% increase in the use of herbal remedies between 1990 and 1997. Let us look next at growth in the number of practitioners of alternative medicine

Sources: "Alternative Medicine." World Almanac and Book of Facts. Annual 2001. p. 508; National Center for Complementary and Alternative Medicine. National Institutes of Health. Nutrition Business Journal. Peter Golden, "St. John's Wort Versus Prozac — All A Matter Of Perspective."(February2000). Online. Available: http://www.supplementquality.com/editorials/stjohns_vs_prozac.html. May 24, 2002. NIH Office of Dietary Supplements. "What Are Dietary Supplements?" Online. Available: http://ods.od.nih.gov. May 23, 2002. Jennifer Ouellette, "The Scrooge of Science."Online. Availble: http://www.salon.com/books. May 27, 2002. Shankar Vedantam, "Against Depression, a Sugar Pill Is Hard to Beat." Online. Available: http://www.washingtonpost.com. May 27, 2002. Donald J. Sutherland, "The Continuing Rise in Prescription Drug Expenditures." Online. Available: http://www.socioeconomic. org/Publi cations/Perspectives/drug price.pdf. May 30, 2002.