Conventional medicine practitioners prescribe medicine based on their track record. Regulators must approve the medications by the US FDA and other national regulators. Regulatory approvals require drugs to be tested in human clinical trials. The process of conducting such trials is laid out.
Herbal medicine practitioners often present case studies as evidence of the efficacy of herbal medicine on a patient or group of patients. Patients and caregivers too often come across anecdotal case studies cited in the literature as evidence of the efficacy of an herb or herb combination in providing relief.
I looked at this question closely while researching for my book – Natural Solutions for Cancer. Many of us cannot appreciate the reluctance of cancer physicians to permit the administration of such herbal medicine to a patient. Doctors engaged in cancer care and treatment are often at loggerheads with herbal practitioners, as I saw first-hand during my visit to the Kidwai Cancer Hospital in India. Doctors refuse to permit the administration of herbal medicine to patients under their care.
Doctors are constantly looking for ways to help cancer patients. I sensed that this reluctance stems from a fear of an adverse interaction with an herb combination. The absence of a formal and robust drug discovery and manufacturing process, especially in Ayurveda medicine, and empirically supported literature on the efficacy of an herb combination lies at the heart of this reluctance.
Even in China, where the State actively promotes TCM and an active research infrastructure has been built, Chinese medicine is still an adjunct to modern medicine. Natural medicine systems are not anywhere soon likely to take the front seat in cancer treatment and cure. It will take a lot of work for these systems to take center stage.
Yet another challenge for mainstream medicine’s reluctance to accept herbal medicine lies in the inherent characteristics of plants. The efficacy of individual herbs is not uniform. It varies with variety and the ecological conditions prevailing at the site from where the plant has been collected. Further variations in efficacy may be related to variations in the manufacturing process adopted by the herb medicine manufacturer.
The drug discovery process is time-taking and complex. Herbal medicine researchers and manufacturers are poorly funded and cash-strapped. The resources required to undergo the drug discovery process are not available to them. Most herbal medicines available today do not carry approval (e.g., certification from a leading drug regulator such as the US FDA). Let us examine the drug discovery process to understand why this is so.
In a nutshell, the efficacy and safety of a medication on a set of people are tested. The data generated from these trials are compared with a group of individuals who have been concurrently administered placebos. The data on efficacy and safety is carefully recorded and analyzed. The findings o the trials are then peer-reviewed by an independent set of experts. Such results are often published in an independent scientific journal.
The trial data is then submitted to a regulator who independently reviews it. If the review concludes that the medicine is safe and efficacious, it is then permitted for use. Conventional medicine practitioners are now allowed to prescribe these medications to their patients.
Herbal medicine conventionally does not follow the prescribed clinical trial process. Herbal medicine practitioners directly prescribe these medications. Regulatory approval for such treatment is not available. Given this limitation of herbal remedies, regulators in some parts of the world also require herbal medicine to conduct human clinical trials and demonstrate its safety and efficacy.
Herbal medicine practitioners must adopt some modern scientific practices to popularise herbal solutions. I do observe moves in this direction taking place worldwide. The change is slow, but it is happening. Patients are in desperate need of the best available solution that will help provide relief.