THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 6, Number 2, 2000, pp, 111-113 Mary Ann Liebert, Inc.

EDITORIAL

From Plants to Patients: The Alchemy of Herbs and Healing

H ypericum perforatum, malaria, diarrhea, ho­meopathy, aromatherapy, acupuncture,

and healing come together in this issue in ways that challenge our thinking and perception at many different levels. The debate and all the salient issues conceming the regulation and li­censing of herbal medicines is perfectly encap­sulated in the special editorial by Michael Mclntyre (pp. 114-124). This is one of the most important and lucid expositions on the subject that I have come across. When the facts are con­sidered there can be no escaping the conclusion that all is not right with regard to current U-censing and regulation. The situation in the Re­public of Ireland is nothing short of absurd and gives the lie to the claims of objectivity that the legislative bodies purport to represent. One can only hope that the authorities in the United States of America and the United Kingdom not only recognize this but also use their consider­able influence to rectify the situation so that the public might once again have access to safe and effective treatments. The need for collaborative partnership, facilitative regulation, and effec­tive education among the herbal, pharmaceu­tical, and orthodox medical fraternities is criti­cal if safe, effective herbal treatments are to continue to be available without the strangle­hold of "prescription only" controls. This theme is amplified and deepened in the pho­toessay by Bodeker (pp, 127-129). This is an ex­quisite essay on the subject of antimalarial herbal treatments and their pharmaceutical ex­ploitation is a synopsis of another paradoxical

absurdity. This is that, having found that the malarial parasite becomes resistant to one flavi-noid from the herb artemesia, presented as treatment in isolation, the drug developers are trying to put together the different ingredients in combination to enhance efficacy. Artemesia had of course "done" this from the start and had done so in a way that could have been har­nessed, harvested, and developed at a fraction of the cost of the current strategy. It is for rea­sons such as this that Gerard Bodeker's Global Initiative for Traditional Systems of Health (GIFTS of Health) exists; not for the sentimen­tal preservation of traditional herbals but for sound medical, ecologic, and financial reasons that of themselves would ensure the preserva­tion of the species. Such a focus and perspec­tive is sorely needed if there is to be an eco­nomically viable future for health care worldwide and it is for this reason that the World Health Organization and GIFTS of Health hosted a meeting of the Research Ini­tiative on Traditional Antimalarial Methods, which is reported in full (Bodeker and Wilcox, pp. 195-207). One can only hope that this ini­tiative will spawn others with equivalent re­spect for indigenous knowledge, as well as commitment to scientific, economic, and hu­mane understanding.

Forty thousand children under the age of 5 are believed to die from diarrheal illness in Nepal. In this context the paper by Jennifer Jacobs and her colleagues (pp. 131-139) offers hope. They have looked at the effect that lim-

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ited individualized homeopathic prescribing one that researchers into integrated health care had on the duration of diarrheal illness. The and complementary and alternative medicine, finding of a statistically significant reduction in in their desire to standardize and control con-the duration of diarrhea has clinical relevance ditions, neglect at their peril. The experiential in that it not only makes the condition easier to is at the heart of the papers by Neil Abbot (pp. manage, but diminishes cost because less oral 159-169), Craig Brown (pp. 171-176), Robert rehydration is necessary and the remedies are Charman (pp. 177-180) and Annie Mitchell extremely cheap to produce and to prescribe, (pp. 181-186) that follow. Abbot has given us One wonders whether a more extensive study the first systematic review of healing as a ther-might show reduced mortality and whether the apy for human disease and although, as one pathogen profile at the end of the treatment would expect at this early stage of Cochrane-with homeopathy might be different between type evaluation, he decides that no firm con-the groups. Equally challenging, and to some elusions can be drawn about efficacy or ineffi-perhaps surprising, findings are reported by cacy, he shows clearly that there is something Ethel Burns and her colleagues in Oxford (pp. of import to investigate and that this can read-141-147). This seminal report describes the ex- ily be done in a rigorous and scientific manner, perience of the Oxford team after using aro- These issues are taken up by the other authors matherapy in more than 8000 women giving from their different professional perspectives: birth. This must be by far the largest sample Craig Brown (pp. 171-176) as a family practi-yet reported, which makes the findings of con- tioner and the president of the National Feder-siderable interest even though it is a "simple" ation of Spiritual Healers, looking at meth-evaluative study. This is a hugely significant odological problems; Robert Charman (pp. piece of work. The finding that the use of pethi- 177-180) revealing that electroencephalographic dine reduced from 6% to 0.2% during the findings offer objective evidence for a physio-course of the study raises important questions, logic basis to the phenomenon of healing; and especially because it is emerging that, with the Armie Mitchell (pp. 181-186) bringing to the cessation of this innovative work, the use of fore the importance of the qualitative issues of pethidine is again rising. One can only hope value and meaning to the research agenda for that these figures will continue to be monitored the evaluation of the relevance and effective-for future reflection and analysis. The full re- ness of healing in clinical practice. There port with the raw data can be accessed from emerges a very clear need for outcomes to be the listed Web site. The study raises many hy- agreed upon that are relevant to both patients potheses that can now be tested and explored and practitioners. Perhaps the authors will be further, again with the potential to greatly im- able to submit some proposals on this after prove the experience and outcome of birth for their next meeting for the readership of this mothers and babies and, in all probability, for Journal? Many other questions are raised by, their health care professionals as well. but not in, these papers. For example, the dif-

Janovsky and colleagues (pp. 149-155) fol- ficulty of establishing real "sham healing," or low this paper with a fascinating vignette on how long an intention must be held to be ef-the tenderness of the Spleen 6 (Sp6) acupunc- fective, indeed whether healing itself takes ture point. The study is compromised by its time, and whether one can in fact experiment small number of participants but the paper elo- with "belief" because to choose a belief is per-quently explores the many issues raised by the haps an oxymoron. Robert Charman's paper investigation. It is apparent that all those in- (pp. 177-180) summarizes evidence of direct volved who have any experience of using Sp6 brain-to-brain transfer of information—that the are aware of differences in sensation among pa- brain itself behaves as a sense organ not just as tients if the point is located in the usual way a processing system for inputs from other by palpation but that the attempt at standard- senses. If this is true, then "blinding" and "ran-ization probably obscured the experiential ev- domization" become very challenging and idence. In this seemingly simple exposition is might even be impractical. Clinical trials are contained a profoimd and far reaching truth; done to detect an effect not accountable for by

EDITORIAL 113

a placebo response. A placebo response how- tually commonplace, then the problem of iden-ever is an improvement in the patient's condi- tifying states or ascribing cause and effect be-tion that has occurred without the coincident comes even more hazardous. These are crucial presence of those factors that are considered to issues because it seems that what matters to our be critical for reproducible therapeutic success, patients is how they feel about themselves and It is frequently attributed to the "state of mind" their lives, not necessarily life at any cost, and of the patient and/or practitioner. If healing this is very difficult to capture, measure, or en-and the response to healing are "state of capsulate, a point not lost on Craig Brown (pp. mind "-dependent, then there is a real problem 171-176), who explicitly mentions both how that is not insurmountable but requiring so- difficult it is to convert experience into words phisticated design and evaluation. The diffi- and the common observation that "describing culty of ensuring "blinding" is obvious and, if it may lessen [it]." Ultimately, it seems to me stratification is to be based on "state of mind," that this is what science, medicine, and healing it will be necessary to know what it is (proba- are all about and it appears that the subject of bly dynamically) or how it changes. "States of integrated health care is our current reminder mind" however are not readily accessible to of j ust how important it is to try not only to rec-outside observers, and language—particularly ognize when we are constrained in our think-in the form of a questionnaire—is a very blunt ing but to go beyond that and stretch our hori-instrument. There is no way to even know if a zons for the good of our patients and our person's responses are truthful, let alone to ver- intellects as well! ify inferences about that person's "state of mind" by actually entering the mind of the Kim A. Jobst M.A., D.M., M.R.C.P. LF.Hom. other person. The Grinberg-Zylberbaun exper- Editor in Chief iments showed that information transfer be- Glasgozv Homoeopathic Hospital tween two "empathically bonded" people fre- 1053 Great Western Road quently occurred at a subconscious or barely Glasgow G12 OXQ conscious level. If such communication is ac- Scotland