the myth of natural medicine suppose you're on the hottest new realitygame show on tv. we'll call it "wud ya eat it?" the host, a man composed entirely ofperfect teeth and focus-grouped hairstyle, offers you two choices. you can choose door 1, behind which is a grilledswordfish steak with a butter sauce. or you can choose door 2, behind which isa grilled collection of everything found in 10 cubic kilometers of sea water from thenorth atlantic. the host points out that door 2 might containsome lobster, and is likely to contain a much larger portion of swordfish than door 1. butthe catch is that, regardless of your choice,
you must eat all the seafood behind that doorto win the million dollar prize. which door would you choose? i think you'd be a fool to choose door 2.there's no telling what will be in 10 cubic kilometer of ocean. depending on where they'vesampled, you could get a sea snake, a blobfish, sea star. the dish may be poisonous or toxic.mixed into that may be some great stuff, but you'll have agreed to eat a lot of thingsyou probably don't want to. now imagine that the show is about medicine.you can choose between a purified plant product, a chemical... with known pharmacological effects,or you can eat the whole plant to treat your disease.
for the most part, i think it would be unwiseto eat the whole plant without knowing what else you're getting along with it. and yet,millions of people make the decision to go with door number 2 because they think it'ssafer to eat a plant than a chemical. how many times have you heard someone saysomething to the effect of "i prefer to take echinacea because it's all-natural" or "iworry about how toxic medicines are, so i use bee pollen to treat my asthma". there'ssomething of an anti-medical, anti-science undertone to these kinds of comments. anotherfavorite is "people have been using spirulina for centuries to control their diabetes". i want to give you three examples of naturalproducts and the evidence about their effectiveness
and safety. along the way, we'll try to separatethe wheat from the chaff about herbal cures. 1. the first example is taxol, and this isreally one of those wonderful cases that typify drug development from natural products. itwas discovered by the national cancer institute as part of the construction of what is calleda compound library from botanical sources. these libraries consist of hundreds of thousandsof vials of chemicals obtained in various ways from natural products and represent oneof the richest sources of new drug leads. taxol was a small compound that was a veryminor component of the bark of the pacific yew tree. in some early tests of crude mixtures,the pacific yew extract was very effective at killing cancer cells growing in a flask.that got it flagged for further analysis and
purification. to make a long and fascinatingresearch story very short and uninteresting, taxol was finally isolated and characterizedafter almost 30 years of work. it's been a major innovation and a front-line drug forcancer intervention of a broad spectrum of patients and cancers. if you decided you prefer to get your taxolfrom natural sources, you'd need to eat the equivalent of about 60 pounds of pacific yewbark for a single gram of taxol. okay, so you're not going to do that, so you decideto make a natural extract of the bark. for that, you'll need ethyl alcohol and a derivativeof castor oil, another natural product, called cremophor el. this is a very toxic substance,and represents the dose-limiting component
of conventional taxol therapy, which is justa bark extract, after all. fortunately, researchers have developed twoalternatives to the very toxic natural substance. they have a modified delivery system thatuses albumin protein, found in chicken egg whites, to deliver the taxol, which greatlyreduces the toxicity. this formulation is called abraxane. they've also developed a semi-synthetic formcalled taxotere that can be synthesized from the more environmentally friendly englishyew, and actually has a longer mechanism of action and slightly reduced side effects. in the case of taxol, the natural productcertainly kicked off a major discovery in
cancer treatment, but the source material,pacific yew bark, is a nonviable therapeutic. anyone who tries to sell you natural yew treeextract isn't doing you any favors. 2. our next example is st. john's wort. i'm going to use this as a counter-exampleto taxol. st. john's wort is that rare exception where the herb is sometimes superior to thedrug. in germany, this herbal product is very commonly used to treat major depression. insome, but not all, clinical studies, it was superior to a placebo, had fewer side effects,and performed as well as the pharmaceutical standard of care. we should take this witha grain of salt. anti-depressants are an area of medicine that may not be very evidence-based,so the responses we get from either drug or
natural product are going to be strongly affectedby the accuracy of the underlying diagnosis. there are some studies that show st. john'swort to be no better than placebo, including one by the major us alt-med group, the nationalcenter for complementary and alternative medicine. it's also been observed that studies in germany,where st. john's wort is part of a folk-medicine tradition, are much more likely to find apositive outcome than non-german studies. this suggests a bias or experimental designissue that should be addressed. the mechanism of st. john's wort is not wellknown. it's been measured to reduce seratonin re-uptake, but the active ingredients havenever been successfully purified. it's not without its side effects, although they'reusually slightly less than the ssri-based
modern anti-depressants. st. john's wort isvery toxic to cattle, horses and other grazing animals. it's especially bad for the young,and can cause failure to thrive, skin lesions, and even coma at higher dosages. that kindof information is important when considering whether the herbal therapy is, in fact, saferthan the pharmaceutical alternative. the most important human side effect is photosensitization,either directly or through toxic effects on the liver. exposure to sun can result in skinlesions. the active ingredient in the herbal remedy is found in breast milk, so it shouldnever be used with nursing mothers. you'll notice that these warnings sound anawful lot like the kind of warnings you might hear in a drug commercial. there's a reasonfor that. any molecule that inhibits or in
any way interacts with biological functionsis going to have a side effect. that's inherent in the way our biochemistry is multi-functional.a drug and an herb that interfere in the same pathway are going to have similar side effects.it's only our perception that supposes that because something is leafy and green thatit's somehow less toxic. many plants develop toxins as a defense mechanism. those toxinsinterfere with normal functioning physiology. when we come along and co-opt that toxin toprovide a specific kind of interference, we shouldn't be surprised that the effects canstill be toxic. 3. red yeast rice red yeast rice is fermented white rice thathas a coating of fungus called monascus purpureus.
it's used in traditional chinese cooking andmedicines, and imparts a red color and slightly nutty flavor to dishes, including peking duckand red rice wine. in the 1970's, researchers extracted an active ingredient from the monascusfungus, called monacolin k. chemical tests showed it to be chemically identical to thepatented drug, lovastatin, marketed by merck as mevacor. this was one of the key statindrugs that were shown to lower bad cholesterol and decrease risk of a second heart attackafter the first one. the merck product mevacor was produced from a related fungus mold calledaspergillus. red yeast rice has been very poorly studiedin the us and europe. clearly it has a biological effect through the monacolin k, but thereare dozens of other monacolins where the effects
are not known. they might be beneficial, orthey might be very harmful. unfortunately, the effective dose required is quite high.you're not going to get it in a normal chinese diet, it must be in the form of supplements.this is why i used the analogy of the game show a the beginning of the video. our choiceis to use the expensive purified product or to take a cheaper, complex mixture of possiblyactive compounds. my own choice would be for the well-characterized purified product, butnot everyone agrees, and a good case can be made that the cost effectiveness of red yeastrice makes it a good substitute for those who can't afford pharmaceutical statin regimens. legally, red yeast rice is in limbo in theus. you can buy it in food form, and there's
a grey area of "food supplements" that don'tadvertise any benefits, but the fda has come down on the import of certain products withhigh monacolin content. there's also a second issue that has to dowith adulteration. due to the cost of fermenting the rice in batches, some manufacturers stretchthe product with industrial red dye. food product regulation in china may not be upto the task of ensuring quality of a product used as a pharmaceutical. side effects ofred yeast rice are similar to the purified statin drug, and can include muscle pain,cramping, and liver damage. to conclude:while natural products are of great benefit to our ability to treat disease, they representa mix of known and unknown compounds and are
not subject to the same level of testing andregulation as pharmaceuticals. that creates a potential risk that might be avoided byisolation and purification of active components. a good case can be made about the accessibilityand cost of those natural cures that have undergone rigorous testing, but the potentialtoxic effects should also be included in the analysis. my own advice, as always, is to ask a trustedphysician before you start eating any green and leafy that doesn't come in a salad. don'tbe suckered into believing that just because something grew in the dirt, it's good foryou. if you don't believe me, go help yourself to a big bottle of castor bean oil or syrupof ipecac and tell me how that works for ya'.
thanks for watching.
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