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NCRHI News, July/August 2000

Volume 23, Issue #4

PAT-ON-THE-HEAD CURE

Cure illness by receiving a pat on the head with the hand? That's what Koji Takahashi, the leader of a Japanese cult called "Life Space" believes and practices. He was arrested, along with six of his followers. When a mummified body of a follower was found in a hotel room last November. As if this cult wasn't bizarre enough, the mummies family claims he is still alive and receiving pats on the head for a brain hemorrhage. [Tokyo, Reuters, undated]

TRAINING LEADS TO OVERCONFIDENCE IN PHYSICIANS' DIAGNOSES

Hal Arkes, professor of psychology at Ohio University, thinks that the way physicians trained creates overconfidence in the way they diagnose patients' disorders. Arkes examined malpractice lawsuits. Physicians called to testify concerning how a particular case should have been diagnosed, have an advantage when they know the outcome and the correct diagnosis. Knowing how the case turned out "biases their perception of what should have been done." Arkes explains that the way physicians are trained is the reason for their hindsight bias. Diagnostic skills are developed and practiced in clinico-pathologic conferences, where a medical case is presented. During these conferences one doctor is asked to make a diagnosis while the others sit and watch. Using these conferences as a testing laboratory, Arkes noticed that if the wrong diagnosis were made, audience members would invariably claim they would have known the correct answer.

Foresight v Hindsight. During the study, Arkes and his colleagues split one audience of 80 doctors and students into foresight and hindsight groups. Both groups were asked to determine a cause of death. The researchers found that those in the foresight group were less likely to have a correct diagnosis than those in hindsight group. They also found the subjects in the hindsight group went through a different mental process than those in the foresight group because they already knew the diagnosis. As a result, the hindsight group perceived the task to be easier. As Arkes noted, prior knowledge added to the students feeling of confidence, thus losing a "wonderful educational opportunity." The researchers also found the hindsight group with more experienced doctors claim that they wouldn't have known the correct answer. Arkes said that this finding suggests that younger doctors with less experience, who most need the educational training, are more likely to be overconfident. The study was presented Feb 22 at the American Association for the Advancement of Science meeting in Washington, DC, "To inoculate oneself against the hindsight bias, consider the alternative outcomes," Arkes recommended. This may be a probable way for teaching hospitals to eliminate the hindsight bias. A possible way to eliminate the bias is to have doctors and students list possible diagnoses before the actual diagnosis is revealed. Although they may choose the wrong answers in difficult cases, the doctors and students will get better at diagnosing in the long run. "It's important to try to get people to say what they would have done without knowing how it turned out," Arkes said. [2/23/00, Medical PressCorps News Service]

COMMON SENSE AND SCIENCE IN MEDICINAL HERBS

Dr. Varro E. Tyler, one of the world's leading experts on medicinal herbs, recently gave a talk to the first International Scientific Conference on Medicinal Herbs at the University of North Carolina at Chapel Hill. Dr. Tyler, is the distinguished professor emeritus of pharmacognosy and dean of pharmacy emeritus at Purdue University. He is of the opinion that, because plants have been used to treat illness since before modern humans evolved and appear to remain popular into the foreseeable future, the medical community needs to combine some common sense with good science when it comes to medicinal herbs. He goes on to state that herbs are in use by one third of the US adult population. Therefore he poses the question as to why the FDA is making it unnecessarily difficult to approve them as medicinal drugs.

Dr. Tyler goes on to compare the US to more "advanced" countries like Germany who requires only a reasonable amount of proof to accept of evidence for the effectiveness of phytomedicines, allowing the products to become an integral part of their mainstream medicine more quickly. Dr. Tyler backs up his theories by giving a brief history of herbal medicines. He says the ancient origins of herbal medicine are well known. Archaeologists have found varied amounts and types of medicinal plants in mummified remains as far back as 60,000 years. The evidence points to the use of herbal medicine was at its peak in the United States during the latter years of the 19th century and the early years of the 20th. During their heyday, hundreds of herbal products were available, usually with high alcohol content. Many of the advertising claims made for them were outrageous prompting the Food and Drug Act of 1906. An interesting thing happened during the '70s and '80s. Scientific and clinical reports emerged from advanced European countries, especially Germany, indicating that the herbal remedies, which had never been totally discarded there, seem to have substantial therapeutic and economic benefits for the consumer. Even such all-American herbs such as echinacea and saw palmetto were found by European scientists to have health benefits without significant side effects. Americans began to demand them. By the late 1990s, annual sales reached almost $4 billion in the US. But in America The Food and Drug Administration insisted that to obtain it's approval, herbs had to meet the same costly standards of evidence as the new synthetic drugs. Because there was no way to patent long known herbs, companies were not willing to make the investment required to prove their efficacy, which, in turn, hurt their marketability. The FDA's lack of support for herbal medicines and the former FDA commissioner Dr. David Kessler's insistence that those involved in the field were "snake oil salesmen," seemed intent on all but removing such unproved herbals from the US market. But the FDA backed off when Congress received more complaints than it had on any subject since the Viet Nam war. "I can imagine, with tongue partially in cheek, our overcrowded courts dealing with cases involving the possession...of a bottle of prune juice purchased for use as an unproved laxative," Tyler said. Then in 1994, the Dietary Supplement Health and Education Act became law. Its purpose was to keep products on the market, but didn't allow therapeutic claims to be made for them. Instead, the law required a statement on the label noting that the herbs inside were not good for anything. "Users disregarded the label and turned to other sources, books, pamphlets, fliers and the Internet for information," Dr. Tyler said. "Much of what they found was hyperbolic in character, designed to sell the product, not to inform accurately."

Then new FDA regulations, published in January, 1999, allowed for more liberalized for herbal products, but these are confusing and inconsistent to consumers. What this boils down to is that regulations still don't meet the need for accurate information about safety and effectiveness. The act fails to establish standards of quality for individual herbal products, which Dr. Tyler says "without question, is the biggest single problem in the entire field today." Another growing problem is companies tend to "borrow" science from other reports to claim their products are just as safe and effective without giving their own evidence to support their claims. Plus the herbal market has been flooded with so many junk products that consumer are confused as to what really works. Of course the news media hasn't helped matters much. Stories about negative drug reactions involving herbs continue to be blown out of proportion because "negative stories sell newspapers." Too often journalists, physicians and scientists have been unaware of, or disregarded, the scientifically valid clinical trials of various herbs that have already been conducted. So it seems that the attitude of the uninformed professionals need to change before herbs will ever be common place in the nation's medicine cabinets. To the degree that consumers need to stop subscribing to nonscientific beliefs, herbal manufacturers must abandon insupportable claims to work toward a standardized quality control. At the same time the FDA should be working to adopt a reasonable policy toward herbal medicine, with government supported research. "Even after working in the field of plant drugs for nearly 50 years, I remain an optimist," Dr. Tyler said. "After all, for much of that period, natural drug products were scorned by professionals and the public alike. Now they are highly valued, and with good reason, by a very large segment of the population." [David Williamson--excerpted from lecture March 2, 2000 at University of North Carolina at Chapel Hill]

[Editor's note. This article is presented because many NCRHI members respect Dr. Tyler's strong stance for evidence-based herbal products, and sensible government regulation. But, whether or not even high-quality herbal remedies will ever live up to his expectations remains to be seen. In any case, Dr. Tyler's lamentations on the present marketplace fiasco is well-said.]


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Items may be be reprinted without permission if suitable credit is given.

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