There are concerns that traditional #herbal medicine lacks sufficient scientific validation and may not meet basic standards of safety and efficacy, but there is also concern that mainstreaming herbal medicine will threaten or uproot it from its classical foundation. There is tremendous need for a comprehensive way to evaluate herbal medicine efficacy and safety while integrating the concerns and experiences of medical providers, scientists, traditional practitioners, and those taking herbal medicines for themselves. Let's see if we can dig in a little to better understand both sides of this argument.
Evidence-Based Medicine
The term "evidence-based medicine" is often used in healthcare and is described as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." It has become the sort of hierarchic methodologic model of evaluating and ranking evidence for determining what defines best practice. However, evidence-based medicine has arguably excluded the practitioner's clinical judgment and experience. Many argue that evidence-based medicine serves only to cut costs and suppress clinical freedom. It has been termed a "cookie-cutter" medicine, systematizing patient treatments according to specified protocol. Ironically, this appears to be a backward step in light of patients' increasing demands for greater individual attention in medical care.
The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. This external evidence can inform, but never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision. Having said that, The World Health Organization (WHO), and numerous individual nations, in recognition of the widespread use and significant value of traditional medicines and the value of varying levels of evidence, have adopted standards for evaluating and approving the efficacy and safety of traditional herbal medicines. They utilize scientific evidence, expert opinions, historical and traditional data, and ethnobotancial information.
Keep in mind, there is the mindset that while some complementary therapies, such as prayer and homeopathy, do not need to stand up to classic methods of safety and efficacy testing, herbs do because they have pharmacologic potential. Therefore there is this implicit expectation that they should work as expected and be known to be safe, similar to the standards set for conventional drugs. Although this makes good sense, it is not entirely reasonable in practice. Whole herbs are not the same as isolated drugs, nor are they applied as such by botanical medicine practitioners. Typically, botanical medicines are prescribed as multi-ingredient formulas, or as single herbs, but as a whole plant or whole plant extract. The science that evaluates pharmaceuticals can't be extrapolated to botanical medicine use.
Lack of sufficient studies does not mean inefficacy. Random control trials can only answer specific questions for groups of people, but herbal medicine is about individual circumstance. Further, one can't assume that random control trials aren't biased themselves. Politics invades medical care and its supporting research. Publication bias has more recently put literature into question. Interestingly, while a negative case about any particular herbal supplement is published, it is often followed by a cascade of negative popular media reports while we ignore the third leading cause of death in our country, medical error. There appears to be a double standard in the reporting of potentially harmfulness of herbs compared with the volume and severity of reports on the risk of pharmaceutical medications. In Europe, where millions of units of herbal products are sold and market surveillance and adverse effects reporting systems are well established, there too are an amazingly small number of adverse reports. In spite of billions of dollars of herbal products sold in the United States alone, there are negligible reports of adverse effects compared with the volumes reported by drug events. Ironically, coronary bypass surgery was used for over 20 years before it was subjected to clinical trials, which is true to for neonatal resuscitation steps, such as utilization of oxygen which we now understand to have a toxic risk to neonates.
Expert Consensus
Clinical decision making has been based on observation, personal experience, and intuition until just the past few decades. Even the random controlled clinical trial is only about fifty years old and has been the definitive method for testing new drugs since only 1980. Maternal and child health is overwhelmed with medical intervention that has never undergone study but has since become the standard simply because of familiarity and common practice. Although herbal medicine may be dismissed as a rouge practice, there are thousands of well-trained, highly knowledgeable and experienced clinical Western herbalists in numerous countries that offer validity to botanical medicine. In Europe, particularly in Germany, #phytotherapy is an accepted part of medical practice. This large body of knowledge from contemporary clinical practitioners provides compelling evidence for the use of herbal medicines. Case studies, case series, uncontrolled trials, observational reports, and outcome-based studies all contribute important information to the dialogue on botanicals, ranging from establishing clinical effects to providing clinical insights.
Honestly, if one were to offer a quick examination of the studies available in the medical library database, they would find an extensive list of references. Europe has been conducting medical research on botanicals for decades. The NCCAM has prioritized herbal research in the United States and the Cochrane Collaboration has offered a number of positive reports on botanical healing therapies such as ginkgo for cognitive impairment and #dementia, #echinacea for colds, St. John's wort for depression, chaste berry for #PMS, horse chestnut for venous insufficiency, and feverfew for #migraines. Very few have botanical approaches have been disproved or proven dangerous.
A Woman's Intuitive Way of Knowing
Women healers have depended on relationships with their clients enhancing their intuitive sense and offering increased perceptiveness in their interpersonal relationships. Their compassionate and empathetic methods of understanding health and disease along with their understanding of physiology and pathology is unique to their practice and success. The primary reason that women seek the care of alternative practitioners is because they desire a meaningful relationship with their care provider.
Women healers are said to bring all their senses into the care they provide their communities. They listen to the stories of women - with their ears, their hearts, and their intuition. They don't fragment their care into objective points of data to suit the objective needs of science. They don't reduct individuals to points on a data sheet or statistics.
Women healers have appreciated that women often require life-style changes to restore their health, as much as they may need medical treatments and cures. Illness does not just occur in the body, but also in their hearts and minds. Women need to be reminded to nurture themselves, but social issues such as poverty, racism, sexism, violence and even judging a woman on her physical appearance is an important part of their overall wellness.
This intuitive sense has historically, been very respected and honored. Women have been thought to be more in tune to our guts, presumably because of our connections in pregnancy, birth, and menstruation. We have connections with our babies, a sense of knowing when they are in danger. Breastfeeding mommas know when their babies need to eat even when they are miles away from us. We also have an awareness of our own body's messages, when we are embodied and listen to them. Our feelings and intuition help us decide how to respond. Learning how to hone in on these skills is a lifelong skill, but one that is vital for optimal health, for living a life of vitality.
This skill takes practice and is part of why I love #yoga so much. Try to notice when your body alerts you to eat, drink, move, rest, or go to the restroom. How long does your body have to alert you before you recognize these signals and honor them? How do you notice them? How do you response? Do you eat when you are hungry or do you think about what you should eat prior to eating? Do you skip meals or afraid to eat? Do you urinate when you first feel the urge or wait until you are experiencing great discomfort? Do you recognize fatigue or do you push yourself to get more done, collapsing at the end of the day? Do you recognize your feelings? Do you feel safe in expressing them? Do you pay attention to your cravings?
Many have become very #disembodied and simply don't listen to their bodies. They fear every other need is more important than their own. Keeping a #journal can help you recognize your own needs and sensations, as well as your responses and reactions. Again, yoga is one of the best practices for moving yourself into a better state of embodiment.
Our Craft is Complex
The reality is that evidence is helpful certainly. It allows for honest reflection and to appraise our craft, but it isn't the holy grail of clinical practice. There are double standards influencing the attitudes about nonconventional therapies, and that even sometimes, there is a suspension of common sense and significant dehumanization in the quest for evidence-based medicine. Women who are embodied can best optimize their health. The intuition is a guide for us in our healing and certainly an important guide for clinicians who have also attained significant knowledge and clinical expertise. We need to both listen to our gut and proceed with intelligence.
Traditional healers believe that they are not the experts in their client's health - they are. Rather, their job is to help them to own their inner power, their expertise on themselves, to tune in and learn to what their bodies are communicating and to honor their emotions.