Bitter Herbs: Mainstream, Magic, and Menace

If nothing else, politicians are often the quintessential pragmatists. I recently asked a German legislator why his country's national health plan pays for homeopathic and other “unscientific” therapies. His reply was simple. “I can't prove they work, but many swear by them. They seem often to replace our doctors' expensive evaluations and tests and, so far as I know, they are safe.”

In the United States, such remedies attract an enormous and growing number of patients. Their use is so extensive that a 1990 survey suggests that there are, in effect, two parallel tracks for those seeking primary care [1]. The first offers “scientific medicine.” Focusing on services by internists, family physicians, pediatricians, and obstetrician-gynecologists, it is heavily regulated—some feel over-regulated—by governmental and other bodies. The second is often called “alternative care” and is provided by massage therapists, acupuncturists, homeopaths, megavitamin therapists, herbalists, and others. It is largely unregulated. People explore each path with equal frequency and often travel on both, spending lots of money as they go [1]. It is difficult to estimate, however, whether expenditures on alternative care save money for the United States. Would we spend more or less if such therapies were not available?

There is ample evidence that physicians practicing scientific medicine can be dangerous for patients. So, too, with alternative offerings, and Woolf and colleagues [2] provide a good example of this in this issue. Until recently, a Chinese herbal product, “Jin Bu Huan Anodyne Tablets,” was available not only in health food stores but also in the growing number of pharmacies trumpeting the virtues of “natural” remedies. Unregulated, the tablets sat next to medicines that had survived regulatory oversight. Produced by a “drug manufactory” in China, the package insert in the box asserts that the tablets are “good for anodyne, sedative, …