This is the question we pose to our media, ‘do we abandon the potential benefits of botanicals to uphold outdated prejudices, or do we move into a new era of deeper understanding – and better health?’
If you are a regular user of herbal remedies, you may have just shrugged off the article in the Daily Mail as yet another example of herb bashing.
But it was worth paying attention to because in a few short paragraphs, it illustrated so much of what is wrong with the way our media perceives and reports on issues around herbs.
A 16-year-old girl who wanted to lose weight decided to try green tea. Instead of simply going to the supermarket like most of us would, she went online and ordered the tea from a Chinese supplier.
According to the story (1) just 3 cups a day was enough to give her hepatitis.
The authors writing in BMJ Case Reports warn that herbal remedies, including tea and supplements with Camellia sinensis, are ‘readily available from unregulated sources such as the internet and are increasingly used’ (2).
Context is important
Indeed that is true. According to the UK Tea and Infusions Association, without any regulation or official permissions, Britons drink just over 60 billion cups of tea (regular, herbal, fruit and speciality) each year – that’s before we even get to the numbers for green tea supplement use – and most of us certainly don’t think of it as a herbal remedy.
That puts the apparently ‘dozens of cases’ in medical literature cited by the authors, documenting people becoming ill after ingesting tea in the form of drinks, pills, powders and supplements into some real world perspective – and equates to a number so infinitesimal that it would be hard to quantify it as a meaningful percentage.
In contrast, the respected University of Maryland database lists a multitude of well-researched benefits from green tea including treating atherosclerosis, high cholesterol, inflammatory bowel disease, liver disease, weight loss and several forms of cancer (3).
Even more interesting, WebMD, a website not known for its liberal views, has this to say about green tea:
“The commonly used dose of green tea is based on the amount typically consumed in Asian countries, which is about 3 cups per day, providing 240-320 mg of the active ingredients, polyphenols.” This amount is based on the ‘dose’ typically consumed in Asian countries (4).
This context, was of course missing. As was any acknowledgement that case reports are not studies. They do not carry the same weight and, in isolation, do not allow us to understand anything other than there are exceptions to every rule; and yet they are often reported as if they are the rule itself.
Apart from asking by what standard this story was considered a ‘news’ story, we might also ask why is there still so much antagonism towards botanicals in the mainstream media and why the idea that someone might exercise a choice to use alternatives is still seen as so ‘wacky’.
Negative bias
That there is a negative bias against herbs in the media is without question. We see it far too often, but as a phenomenon it has not benefitted from much examination.
However, one study that looked specifically at the way botanicals were covered in the media found that despite the overall positive results and tone of clinical trials in major medical journals, newspaper coverage of botanical clinical trials was more negative than similar coverage for pharmaceutical clinical trials (5).
This wasn’t a dewy eyed look at herbs. It acknowledged, for example, the often small size of botanical trials and how this can affect outcomes. Nevertheless, the authors noted that when reporting studies into herbal remedies, journalists displayed “a degree of scepticism rare for medical reporting” and that that: “It may be considered more newsworthy to debunk commonly held beliefs and practices related to CAM, to go against the trend of positive reporting in light of evidence.”
They hypothesised also that journalists who used press releases from peer-reviewed, high-impact journals as their main sources may “have subtle biases towards scientific method and conventional medicine.”
These same journalists may turn to conventional experts for comments on study outcomes, for both herbal and pharmaceutical trials, and this can exacerbate the problem of bias.
The influence of advertisers
With commercial magazines and newspapers, and even TV news programmes, there is also the growing problem of advertiser influence.
Pharmaceutical advertising money talks, whether it’s for a prescription drug or an over-the counter one. Few botanical companies have the money to compete, and online content is no safer since on big news sites, content is even more strategically tailored to suit advertisers (6).
But advertiser pressure can make itself felt even before story hits the mainstream.
For instance, a 2008 study of 11 medical journals investigated the relationship between pharmaceutical advertising and articles about dietary supplements in medical journals. It found that:
- Journals with the most pharmaceutical ads published significantly fewer major articles about dietary supplements per issue than journals with the fewest pharmaceutical ads.
- Amongst those journals with the highest percentage of pharmaceutical ads, the percentage of major articles concluding that dietary supplements were unsafe 67%. In those journals with the fewest pharmaceutical ads this figure was just 4%.
- The percentage of articles concluding that dietary supplements were ineffective was almost twice as high (50%) among journals with more pharmaceutical ads than among those with fewer pharmaceutical ads (27%).
Overall, the more pharmaceutical advertising there was in a medical journal, the fewer articles about dietary supplements, and more articles concluding dietary supplements were unsafe, there were (7).
Ignorance
The recent St John’s wort recall threw up another media issue – ignorance.
Eight products in total, produced by ASDA, Superdrug and HRI Good Mood, were the subject of a “precautionary recall” (8) because they had levels of toxic pyrrolizidine alkaloids (PAs) above the threshold recommended by the European Committee on Herbal Medicinal Products (HMPC).
Although much was made in the news coverage of the toxicity of PAs and potential dangers of herbs containing them, most missed a vital fact: St John’s wort does not naturally contain PAs. Instead the contamination is the result of accidental co-collection of weeds like ragwort during harvesting.
This kind of harvesting contamination isn’t just a problem with St John’s wort, other herbs can be affected. Good Agricultural and Collection Practices, as defined by the World Health Organization (9), are the best way to avoid this problem. So is being careful what you buy.
The fact is that complementary and alternative medicines, including botanicals, are growing in popularity.
In the UK, 46% of the population can be expected to use one or more CAM therapies in their lifetime (10). In the United States, approximately 38% of adults and approximately 12% of children are using some form of CAM (11).
This means there’s a marketplace, and cut price/high volume companies who want in on the action may have less scrupulous quality control than smaller dedicated suppliers. If you use St John’s wort, as with most herbals, there is an argument that you get what you pay for – though this context, too, was lost in the rush to print another bad news story about herbs.
A different language
But there is also another largely ignored influence that makes reporting on herbs so unsatisfactory: language – specifically the way language expresses our beliefs and philosophical underpinnings.
Users of CAM have been consistently shown to be well-educated, and well informed individuals making different choices about how to treat common health problems such as anxiety, backache, chronic pain, and colds and flu – conditions for which conventional medicine can offer very little.
This choice of an alternative isn’t necessarily dependent on dissatisfaction with conventional medicine but is more commonly based on a philosophical orientations towards choice, health, culture, individuality, nature, spirituality and personal growth.
Of course, it is only rarely that these things are reflected in news reporting and even more rarely in medical research, which strives to disassociate itself from such things.
Yet those who appreciate the study and the use of herbal remedies have been described as medically ‘bilingual’ – with the ability not only to understand the varied approaches to health, the differences in language, history and also conceptual differences, but also how the past can positively inform the present.
A good example of this medical bilingualism is Tu Youyou, co-recipient of the 2015 Nobel Prize in Physiology or Medicine (12), and a researcher who has spent her entire career researching traditional Chinese medicine. Tu won the prize for her discovery of artemisinin, derived from sweet wormwood, as an alternative malaria cure to the standard chloroquine, which is now largely ineffective due to resistance.
Tu maintains that she drew her inspiration not from JAMA or the BMJ, or even the Journal of Alternative and Complementary Medicine, but from the medical text of a fourth-century Chinese physician and alchemist named Ge Hong (circa 283-343).
Out of touch
In most parts of the developed world the media has grown deeply conservative and corporate in its outlook. As such it is a media that has proved itself unworthy of the challenge of dealing with alternatives or opposition.
Examples abound from climate change, to alternative energy, economics and new politics – and it is also true in health. However, in upholding the status quo we also have a media that is increasingly out of touch with its readers and the momentum of the times.
Yet occasionally there is a chink of light. As if in a nod to Tu Youyou the Daily Mail also recently reported on a trial of artesunate, derived from the leaves of sweet wormwood, as a treatment for bowel cancer (13).
Scientists, researching the substance claim that early trials show that bowel cancer patients who took the drug for two weeks before surgery were six times less likely to have a recurrence of the disease, compared to those who took a placebo.
This means it could be an effective treatment for the estimated 40,000 Britons who are diagnosed with the disease every year.
The question to our media is: do we abandon that potential benefits of botanicals to uphold outdated prejudices, or do we move into a new era of deeper understanding – and better health?
References
- Davies M, Teenager who drank three cups of green tea a day develops hepatitis and turns YELLOW due to liver damage, Daily Mail, 24 September 2015. http://www.dailymail.co.uk/health/article-3247325/Teenager-drank-three-cups-green-tea-day-develops-hepatitis-turns-YELLOW-liver-damage.html
- Gompertz S et al, Chinese green tea and acute hepatitis: a rare yet recurring theme, BMJ Case Reports, published online 23 September 2015. http://casereports.bmj.com/content/2015/bcr-2014-208534.abstract
- University of Maryland Medical Center, Green Tea. http://umm.edu/health/medical/altmed/herb/green-tea
- WebMD, Green Tea. http://www.webmd.com/vitamins-supplements/ingredientmono-960-GREEN%20TEA.aspx?activeIngredientId=960&activeIngredientName=GREEN%20TEA
- Caulfield T et al, Herbal remedy clinical trials in the media: a comparison with the coverage of conventional pharmaceuticals, BMC Medicine2008; 6: 35. http://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-6-35
- Filloux F, Dangerous blend: how lines between editorial and advertising are blurring, Guardian, 16 May 2011. http://www.theguardian.com/technology/2011/may/16/blurring-lines-between-advertising-and-editorial
- Hood KL and Kemper KJ, Does pharmaceutical advertising affect journal publication about dietary supplements?, BMC Complementary and Alternative Medicine2008; 8: 11. http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-8-11
- Medicines and Healthcare products Regulatory Agency, Precautionary recall – six batches of St John’s Wort Tablets, 8 February 2016. https://www.gov.uk/government/news/precautionary-recall-six-batches-of-st-johns-wort-tablets
- World Health Organization, WHO Guidelines on Good Agricultural and Collection Practices (GACP) for Medicinal Plants, 2003. http://apps.who.int/medicinedocs/en/d/Js4928e/
- Lewith GT and Bishop FL, Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use, Evid Based Complement Alternat Med, 2010; 7(1): 11-28. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816378/
- National Center for Complementary and Integrative Health, The Use of Complementary and Alternative Medicine in the United States, 2008 https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm
- The Nobel Prize in Physiology or Medicine 2015. http://www.nobelprize.org/nobel_prizes/medicine/laureates/2015/
- Mail on Sunday Reporter, The £1 pill taking on bowel cancer: Malaria drug based on a Chinese herbal remedy could be the latest weapon in the battle against the deadly disease, 30 January 2016 http://www.dailymail.co.uk/health/article-3424600/The-1-pill-taking-bowel-cancer-Malaria-drug-based-Chinese-herbal-remedy-latest-weapon-battle-against-deadly-disease.html
