Alternative medicine should be subject to scientific rigor, too

Light Switch

Alternative medicine should be subject to scientific rigor, too

We need science, not hype, to hunt for ideas in traditional medicine

Nearly 20 percent of Americans have used 'natural' health products โ€“ an alternative treatment produced by a living organism โ€“ creating a huge market for complementary and alternative medicine. According to the FDA, in 2014 there were 85,000 natural health products on the market in the US, and this number is ever on the rise.

Unfortunately, it is frequently hard for laypeople โ€“ and sometimes even for scientists โ€“ to sort out which of these therapies are actually beneficial to our health and which ones are just pseudoscientific woo. This problem is further compounded by the wealth of misinformation regarding complementary and alternative medicine readily available to patients. This information gap can be relatively innocuous, in the case of multivitamin and other supplements. And it can be downright dangerous, as in the case of amygdalin (laetrile), a compound extracted from apricot kernels which is marketed as a cure for cancer but instead places consumers at risk of cyanide poisoning.

How natural medicine is often sold

U.S. FDA (seriously)

To undercut companies peddling such dubious products, their promises need to undergo scientific scrutiny โ€“ researchers need to work toward understanding what active compounds could be responsible (if indeed there are any present) for the medicinal effects allegedly seen by using natural products. Identifying active compounds would potentially allow scientists to improve their medicinal properties and โ€“ importantly โ€“ allow for quality-controlled mass production.

Honey and royal jelly are two great examples of how research on alternative treatments can benefit us all. Both substances have been marketed as a panacea - from treating wounds, to ameliorating cancer. A recently published scientific article shows how defensin-1, a well-known anti-bacterial protein in both honey and royal jelly, can help heal skin wounds. Furthermore, purified defensin-1 had the same effect on wound healing as an extract of royal jelly, demonstrating that it is one of the major components responsible for the effect of the natural substance. Bee defensin-1 thus appears to be a promising compound for treating diabetic wounds or other wounds which would require a long time to heal.

A bottle of royal jelly marketed as a health product

Mรฉhpempล‘ Bolt / Wikimedia Commons

Similarly, Nobel Prize-winning research into a traditional Chinese medicinal preparation led to the discovery of artemisinin, today a best-selling anti-malarial drug. The discovery of such active compounds present in traditional medicinal preparations can play an important role towards discovering new compounds.

The FDA classifies most natural products as dietary supplements rather than drugs, making them subject to a much less stringent regime of proving safety and efficacy. Additionally, alternative medical preparations such as homeopathic medications are not required to show any proof of efficacy or safety, and this has led to a number of high profile cases such as the recall of products which were contaminated with belladonna. And such natural products are frequently plagued by other issues, such as high batch-to-batch variability and the presence of contaminants, including heavy metals. Research into discovering active compounds in such products could help solve these problems.

At the same time, it is crucial to understand that not all alternative medical systems are equal, and preparations which are found to be ineffective or even downright harmful should be definitively labelled as such by the scientific community for the benefit of the general public. Traditional medicines which do not show any promise in clinical trials should be clearly and widely labelled as such.

It is entirely possible that a wealth of medical knowledge, refined over decades and centuries of observation and experimentation, is hidden away in complementary and alternative medical systems such as ayurveda, traditional Chinese medicine, and herbalism. But in order to fully capitalize on this knowledge, it is crucial we make use of the in-depth understanding we now possess of biological systems to understand whether, and how, natural product preparations work.

Now is the time for researchers to carefully analyze which ones show promise and to convert them into potentially game-changing medications by distilling out active substances. Obtaining such an in-depth understanding of how natural products work would allow us to market these to the world in a safe and medically responsible manner.

Comment Peer Commentary

We ask other scientists from our Consortium to respond to articles with commentary from their expert perspective.

The Massive Science Consortium is the community for scientists who want to have an impact.

Join today

Jack Barton

Cognitive Neuroscience

University of Manchester

Alternative therapies are never far away. For example, there are plenty which claim to be able to send you off into a better, and deeper, sleep, and companies jump on these to promote increasingly dubious products. 

Nonetheless, I like the approach this article takes in that it accepts certain alternative therapies may be useful; it is the role of scientists to understand โ€˜whyโ€™ this is the case. For those compounds that work, this is a logical and intelligent way forward. 

However, for those that do not have a proven track record (e.g. homeopathy โ€“ the NHS was still funding this last year), this is where a greater understanding of placebo effects is needed. Placebos are powerful, but sifting out what has a biological basis, what is placebo, and what is somewhere in between (harder to sift out but not impossible) will save people money and make more sense out of alternative therapies.

I think one step which should come before โ€˜howโ€™ alternative therapies work is to test โ€˜ifโ€™ many popular alternative treatments are more effective than an appropriate placebo. As someone who has worked through the research on alternative therapies for insomnia, the research is poorly conducted, tested in incredibly specific populations, or only conducted on a single individual. Thatโ€™s alongside the poor use choice of placebo comparisons (or complete lack of). If the alternative therapies canโ€™t pass robust science, then we need to make it clear to people spending money on them. If not, then maybe a generic blue pill would work better.

Comment