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IV Saline Solution is not a good analogy, that's a very different case from herbal medicine. People have been using willow bark for pain relief for hundreds if

IV Saline Solution is not a good analogy, that's a very different case from herbal medicine. People have been using willow bark for pain relief for hundreds if not thousands of years. They have not been injecting saline solution. There's reason to believe that, in some cases, it is better to get medicines in their tried and true forms (those used for hundreds or thousands of years) rather than their more recent isolated forms (which only have a few decades of use). There could be beneficial interactions between all those unknown substances. In some cases - again see St John's Wort - the natural herbs are more effective, safer, and with fewer side effects than the concentrated drugs. And they are infinitely more available, since they can be grown right in your back yard. There are of course exceptions to this - there was the very popular Chinese herb that had been used for a thousand years that turned out to give you throat cancer. Don't get me wrong, I use the medical system. I also sometimes use herbal medicine, but I'm much, much more likely to reach for Advil than I am for willow bark. But I understand those who reach for willow bark, and recognize the validity of their reasoning. Personally, I want to see these herbs tested in proper trials so we can determine which are pure placebo, which are effective the way St John's Wort is, and which are dangerous the way that Chinese herb was. If we can identify the ones that are actually effective, then that opens up a ton of room for people to self medicate and frees up resources in the medical system for those who really need them.

derefr 7y ago
The thing is, unless you operate in a system that also has a pipeline for manufacturing and delivering medical marijuana to pharmacies—and the patient is likely to take advantage of that, rather than just using their medical-marijuana card to go to their local head shop—then you as a doctor have a choice to make, between "prescribe them something they can only [in this country] get at a pharmacy, which is therefore likely to be okay", and "prescribe them something they will get wherever the market allows, and thus is of whatever quality the market will bear." It's the "whatever quality the market will bear" part that I worry about. Consider: if you buy a bottle of ground willow-bark sitting on a store shelf in a random bodega... where did it come from? Who made it? Where did they grow it? What are the legal requirements re: pesticides, soil toxicity, etc. in the country they grew it [since it probably wasn't here]? And how certain are you of those answers? And mind you, Chinese herbs are a bit better, even, since they're mostly just considered "food" by standards bodies, and so it's pretty hard to import them (or even derivatives of them) and local growers get regulated for "food purity" by entities like the FDA. (No standards body can protect you from things that inherently contain compounds nobody is aware they inherently contain, of course. Unless some other compound in the herb was considered the active ingredient, and isolated out...) But, well, let me put it like this: my local pharmacy has some homeopathic tinctures (for some reason. At least they're on the bottom shelf out of most people's sight.) Who made those? And, given that they started as poisons before being diluted, how sure are you that they actually "did homeopathy correctly" and diluted them so that they're not actually going to poison you? DIY, then? How sure are you that you can "do homeopathy correctly", instead of accidentally poisoning yourself because you didn't stir your cyanide tincture well-enough? And then, how confident would you be that some big-pharma company could—if they wished—do homeopathy correctly? I'm guessing a lot more than your confidence in either BestElsewhere Imports Co or in your own two hands. That's what I'm getting at. It's not about what happens when you grow it yourself. It's about the worst quality of product the market could potentially deliver to you when you go looking, and what that means for a doctor considering which delivery-vehicle to prescribe.
- dbingham 7y ago
  You're not wrong that herbal supplements are completely unregulated, and I totally agree that its a huge problem. But I still think you're putting far too much faith into the regulation we do have for the drug market. The regulatory agencies have been pretty thoroughly captured by the drug makers. And profit is a hugely corrupting influence. Just look at the insanity that has taken place with the makers of opioids and the opioid epidemic. I think the point is that we need to work to improve the regulation of both concentrated drugs and of herbal supplements. And in the mean time, if people want to use that plant because it makes the feel better - let them. And if their doctor thinks that plant will serve them better than the mass produced drug, let the doctor proscribe the plant. After all, their doctor is the real expert here.

derefr 7y ago

The thing is, unless you operate in a system that also has a pipeline for manufacturing and delivering medical marijuana to pharmacies—and the patient is likely to take advantage of that, rather than just using their medical-marijuana card to go to their local head shop—then you as a doctor have a choice to make, between "prescribe them something they can only [in this country] get at a pharmacy, which is therefore likely to be okay", and "prescribe them something they will get wherever the market allows, and thus is of whatever quality the market will bear." It's the "whatever quality the market will bear" part that I worry about. Consider: if you buy a bottle of ground willow-bark sitting on a store shelf in a random bodega... where did it come from? Who made it? Where did they grow it? What are the legal requirements re: pesticides, soil toxicity, etc. in the country they grew it [since it probably wasn't here]? And how certain are you of those answers? And mind you, Chinese herbs are a bit better, even, since they're mostly just considered "food" by standards bodies, and so it's pretty hard to import them (or even derivatives of them) and local growers get regulated for "food purity" by entities like the FDA. (No standards body can protect you from things that inherently contain compounds nobody is aware they inherently contain, of course. Unless some other compound in the herb was considered the active ingredient, and isolated out...) But, well, let me put it like this: my local pharmacy has some homeopathic tinctures (for some reason. At least they're on the bottom shelf out of most people's sight.) Who made those? And, given that they started as poisons before being diluted, how sure are you that they actually "did homeopathy correctly" and diluted them so that they're not actually going to poison you? DIY, then? How sure are you that you can "do homeopathy correctly", instead of accidentally poisoning yourself because you didn't stir your cyanide tincture well-enough? And then, how confident would you be that some big-pharma company could—if they wished—do homeopathy correctly? I'm guessing a lot more than your confidence in either BestElsewhere Imports Co or in your own two hands. That's what I'm getting at. It's not about what happens when you grow it yourself. It's about the worst quality of product the market could potentially deliver to you when you go looking, and what that means for a doctor considering which delivery-vehicle to prescribe.

dbingham 7y ago
You're not wrong that herbal supplements are completely unregulated, and I totally agree that its a huge problem. But I still think you're putting far too much faith into the regulation we do have for the drug market. The regulatory agencies have been pretty thoroughly captured by the drug makers. And profit is a hugely corrupting influence. Just look at the insanity that has taken place with the makers of opioids and the opioid epidemic. I think the point is that we need to work to improve the regulation of both concentrated drugs and of herbal supplements. And in the mean time, if people want to use that plant because it makes the feel better - let them. And if their doctor thinks that plant will serve them better than the mass produced drug, let the doctor proscribe the plant. After all, their doctor is the real expert here.