Dr Lyall A Higginson
For an embarrassingly long time, our western concept of medicine evolved in tandem with some outrageous quackery and charlatanism. History abounds with examples of alchemists and snake oil salesmen who cry out for caricature. Today, we are dealing with a new breed of potentially dangerous pests: the television and Web fraudmeisters who flog ‘herbal remedies’ and alternative medicines as cure-alls for almost every disease known to humankind. Their customers seem to have no idea that many of these concoctions are pharmacologically active and could pose a serious risk to their health through negative interaction.
However…there might also be a legitimate side to the field of alternative medicine. For one example, the former Royal Patron of the British Homeopathic Association balanced traditional medical care with complementary treatments through a lifelong devotion to homeopathy. And what a long life it was – the Queen Mother reached 101 years of age! It makes me wonder how much of her longevity was rooted in the successful intersection of two schools of thought in medical intervention? Might there be alternative approaches that can work in tandem with our conventional forms of medical treatment?
Although I have been a physician for three decades, it is only during the past 10 years or so that I have found myself acknowledging the role that alternative medicines play in the lives of people in our care. In my practice, approximately 20% of my patients are taking herbs or supplements in addition to what I have prescribed. That number may be even higher, because some patients refrain from mentioning other remedies for fear of a doctor’s unfavourable reaction.
In some cases, patients bring into our consulting rooms a cultural attachment to their homeland’s way of fighting disease. That puts the onus on us to do two things for which our western medical training has not really equipped us. On one hand, we need to know what heritage treatment they believe in; on the other hand, if their herbal remedies are making them sick, we have to be able to determine which (and whose) other remedy can help them.
Empowerment through awareness
In my own Internet searches, I have not yet come across homeopathic or naturopathic associations that claim to be a replacement for our tried-and-true approach to healing. They are careful to stress the complementary nature of their medications, which is one of the reasons why I would like to see their treatment protocols thoroughly tested to see whether any can be applied to the cardiovascular specialty. Which brings us to yet another frustrating aspect of the doctor’s dilemma: how do we find the time to keep up to date on all the literature about alternative medicine now appearing in journals and online?
Last June, an article appeared in the American Journal of Cardiology on xuezhikang (XZK), a red yeast rice extract that has been prescribed in China for centuries to treat circulatory disorders (www.ajconline.org). Using a randomized, double-blind, placebo-controlled, parallel-study group involving 4870 patients, it was found that those treated with XZK showed striking relative and absolute decreases of 45% and 4.7%, respectively, in major coronary events compared with the placebo. They also experienced highly significant relative decreases in the occurrence of nonfatal myocardial infarction and fatal coronary events. Moreover, patients treated with XZK showed a one-third decrease in the need for coronary revascularization.
On the other side of our ever-shrinking world, Cuba has adopted a policy of medicina verde out of economic and political necessity. It is bringing back many herbal potions from the pre-revolutionary era. The past generations of Cuban medical graduates have had orientations in acupuncture, herbal medicine, magnetic therapy, trigger point injections and cupping. (They also study fangotherapy, which, I was delighted to find out, is an organic mud treatment that has nothing to do with extracting teeth!) Of possible interest to cardiologists, Cuban medical specialists have been claiming considerable success in reducing cholesterol levels since the 1980s with an extract from sugarcane wax. They call it ‘PPG’, and in pill form, it is marketed globally in health stores as Policosanol (www.policosanol.com/monograph.htm).
More pathways to hope?
Over the coming years, it will be very interesting to find out the truly viable options among those treatments. How will they interact with our methods? Even if only 5% prove to be of any use whatsoever, lives may well be saved, prolonged or made more bearable. We ought to study nonconventional treatments, design trials, test thoroughly, research the history of their practical application, eliminate the shysters’ concoctions, and regulate the viable products within the scope of evidence-based medicine. We are in the business of bringing hope as well as cures, and there may be something to adopt or adapt from thousands of alternative medicines that have evolved around the world since ancient times. Closer to home, leaves and bark wraps have been time-honoured components of remedies used by the Aboriginal peoples of Canada. We have more to learn from First Nations cultures than we had ever imagined.
Let’s see if we can at least take the practitioners of alternative medicine by the hand, if not fully embrace them, and begin a voyage of discovery. For example, a few such steps were taken in the direction of homeopathy in the past that led to the use of digitalis. The time has come for us to learn just how nature-based healing might apply to cardiology. I do not think it is merely a question of can we or should we go green – it is how far? As with the Queen Mum, it is a matter of balance.
And would we not rather see plant life poured into medicines instead of gas tanks?