… because it’s natural.

I think with this post I am going a bit off topic (or at least getting on a soap box for a bit). Occasionally a patient will say that they don’t want to take a medicine because they want to try other treatments first, like loosing weight or exercising, if,  for example, they were just diagnosed with adult onset diabetes (also known as Diabetes Mellitus, type 2). Now if their numbers (eg, a glycosylated hemoglobin) that is at or near goal for a treated diabetic, that might not be an unreasonable approach. After all, even if someone is put on a diabetes medication, anti-hypertensive, etc, diet and exercise don’t become less important in treating whichever disease they have.  What concerns me at times is if the reason someone doesn’t want medication for a treatment is because the medication is “not natural” and that they want to try something that is derived solely from natural products.

Now on one hand this might not be totally unreasonable in that many common medications are derived from natural products. Think of aspirin and penicillin (the latter produced by fungi known as penicillium).   Streptomycin is another drug initially derived from a natural source. Digoxin/Digitalis is produced by the Foxglove Plant (which was used to treat what we now call congestive heart failure.  Digoxin and digitalis are still used at times). Morphine is derived from Poppies. The list goes on. As I don’t work for a pharmaceutical company, I don’t know how many of these medications are 100% man made vs being derived from plant sources. Given that a pill has a known quantity of a known medicine, I’d rather take that than risk a stroke or some other complication. My biggest issue is someone wants to take a  supplement to treat a disease “because it’s natural” and because “it’s safe”. I want to see the proof that it works before I’d recommend it. Note, if we’re talking about a disease that won’t kill you tomorrow, or next week, I try to be open minded if a patient wants to try something else first.

Having said that, when someone’s reason for wanting to use an herbal treatment, a supplement, etc to treat a disease because natural products are safe/safer than medications, I am apt to give them a list similar to this: Carbon Monoxide, Snake venom, Radium, Ricin, Atropa Belladona (nightshade), Botulinum toxin, etc. Aside from being toxic, they are all natural products as well. It is my way of hopefully, and gently, pointing out that natural doesn’t always mean safe or non toxic.  If someone is hawking a natural product as a “cure” for something, it’s reasonable to ask the following questions:

1) Is it safe?

2) Does it work? What is the proof that it works? For medications it’s multiple trials that are reproducible and show (usually) a clinically significant difference in cure/length of disease/significant decrease in morbidity or mortality. In some cases it is a change in a surrogate end point. Do the natural products have the same level of proof? Of note, a celebrity spokesperson or the fact an infomercial exists isn’t proof. In my mind if someone is saying that “studies show…” then they should be able at some point to tell you where to find the studies, or provide the references themselves. Obscure or non peer reviewed journals don’t count. Nor should there only be one study showing benefit (it should be a really compelling article if there is only one).

3) What are the alternatives?