D  e  s  e  r  t     E  x  p  o  s  u  r  e      january 2005

A Growing Alternative

An herbalist and a physician discuss the increasing integration of ancient and modern medical techniques. When should you pop a pill and when should you consider herbs instead?

By Jessica J. Savage

The recent recall of the popular arthritis drug Vioxx may have left some people dubious about the promises made by prescription drug makers. Merck & Co spent nearly $80 million last year advertising Vioxx, promising arthritis patients "a beautiful morning," and the drug was used by 2 million people worldwide. But Merck had to abruptly yank Vioxx off the market after a study confirmed longstanding concerns that the medication increases the risk of heart attack and stroke.

Las Cruces herbalist Deborah Brandt

In the firestorm of bad publicity and threatened lawsuits, it's only natural to wonder if--at least for some ailments--patients shouldn't explore alternatives to prescription drugs that are, well, more natural. We talked with two Las Cruces health practitioners, Deborah Brandt, a clinical herbalist, and Conchita Paz, MD, a family practice physician, about some current issues in health care including the subject of herbs vs. drugs and the rising costs of health care.

Everything about Brandt's appearance and demeanor is down-to-Earth, including her herbal knowledge, which--as she frequently points out--is grounded in thousands of years of cultural use. Indeed her shop and clinical practice are called From the Ground Up.

"She's very natural," says client John Melcher. "She speaks from the soul."
With new clients, Brandt spends one hour on an initial health evaluation she does as a Clinical Professional Herbalist and Registered Nurse, to establish a foundational relationship between health practitioner and client.

"That is the essence of healing," she says. "Socrates knew that. Shamans knew that."
During that first hour with Brandt, she explores what's going on with a client emotionally, mentally and spiritually, as well as physically through her interview process. "I try to bring them into soul awareness with their own being," she says. "No one can tell you what to do. I want them to realize their potential as a whole human being."

Brandt says more herbalists and acupuncturists are needed to meet the demand for alternatives in medicine.

Trained in the clinical specialty of psychiatric and mental health nursing, Brandt says becoming an herbalist allowed her to expand her ability to help people. She was trained in 1993 at the Southwest School of Botanical Medicine, located in Bisbee, Ariz., and became a professional member of the American Herbalist Guild in 1995.

Instead of increasing the conflict between old and new ways of treating illness, Brandt says society would be healthier if the two disciplines came to terms with each other. "I see myself as bridging the gap between modern and traditional medicine," the herbalist says.

Modern medicine is relatively new compared to traditional medicine, which has relied on herbal remedies for thousands of years, Brandt says. Physicians in the medical society have to change their mindset about traditional medicine if they want to keep up with where the public is, she argues: "It's to the physician's detriment if they don't study the roots of medicine."

The herbalist acknowledges the contributions of modern medicine that have contributed to health and saving lives such as CAT scans, MRIs and antibiotics. Yet technology can be a distraction for a physician if it means becoming more focused on test results than on the actual patient.

"We need to take more time to learn about patients," Brandt says. "We've gotten away from the physician/patient relationship."

Health care in general has become burdened with corporate and administrative high costs in areas such as biotechnology and pharmacology, referred to by Brandt as the "money-making game of medicine," which she says is motivated by greed.

For herbalists, getting back to basics means not only knowing your patient, but knowing medicinal plants and herbs. "A single herb can have hundreds of constituents," Brandt says, "whereas a drug has one."

"A silver bullet," is how the herbalist refers to drugs, which are "powerful and have a higher profile of side effects and a narrower range of safety," she says. "Whereas, most herbs, with exceptions, have built-in buffers that counter side effects. A drug can come from a single element, which means more side effects."

Brandt says that too often herbs are compared to drugs, but it's a poor comparison. The basic premise that herbs are dangerous is wrong, she says.

"I work with herbs all day, all the time," the herbalist says. "There are very few bad effects and they're not life threatening. Yet every year there are deaths from prescription drugs. It's a leading cause."

The Food and Drug Administration's (FDA) 2003 ban of dietary supplements containing ephedra would seem to be an indication that some herbs are dangerous--much like the Vioxx recall for prescription drugs. Ephedra is a naturally occurring substance derived from plants; its principal active ingredient is ephedrine, which when chemically synthesized is regulated as a drug. In recent years ephedra products had been extensively promoted to aid weight loss, enhance sports performance and increase energy. The FDA found little evidence of ephedra's effectiveness except for short-term weight loss, while concluding that the substance raises blood pressure and otherwise stresses the circulatory system. These reactions were linked to significant health problems, including heart ailments and strokes.

Brandt, however, says the ephedra problem was more a case of it being self-prescribed for a use inconsistent with how the herb is used in Chinese medicine. Called "ma huang" in Chinese Aruveyda medicine, the herb is prescribed for weak, debilitated people for treatment of colds and asthma, Brandt explains. It wouldn't be prescribed to large people who are easily overheated. For certain conditions and at the right dose it's a good medicine, she insists.

"That's why we need herbalists to evaluate people," Brandt says.

It's the everyday conditions, rather than the life-threatening ones, that should bring clients to the herbalist. For example, many inflammatory-based conditions such as arthritis and swollen prostate are helped by the antioxidants in herbs and plants eaten as foods. "Inflammatory conditions contribute to disease and cancer," Brandt says.

Many common spices such as curry, cloves, ginger and peppermint contain potent anti-inflammatory agents that aid digestion without irritating the stomach.

The University of Arizona School of Medicine has been gathering research on food as medicine in treating modern chronic diseases, Brandt says.
Physicians don't typically recommend botanicals, she says, yet herbs can assist antibiotics in the treatment of infections by restoring normal flora in the intestines and stimulating the immune system.

"We all know that antibiotics are overused," Brandt adds. "That's why there's super bugs and our own bodies can't resist infection."
While Brandt acknowledges that antibiotics have saved many lives, she says a physician often won't investigate whether an infection is viral- or fungal-based, which determines whether or not it will respond to antibiotic treatment. For example, a person with a sinus infection caused by fungus will get better on antibiotic therapy, Brandt says, but then the infection becomes recurrent.

"Physicians are so busy that they rely on drug company information that is biased," Brandt charges. "They're not looking at the real research."
Botanical-based medicine is practiced in Europe and there are a few physicians trained overseas that bring that knowledge to their American practices.

When deciding to go to an herbalist, Brandt says to go for anything you would go to a regular physician for, and she offers some advice on selecting an herbalist: "What is their reputation? Call the American Herb Guild, ask around." Ask where the herbalist studied, how they learned their craft and ask for references, she says.

"We need more practitioners of traditional healing methods. It's something that needs to be explored," Brandt says. "It's not wacky, New Age stuff. Herbs have been used for thousands of years."

When Las Cruces family practice physician Conchita Paz comes into an exam room to see a patient, she brings a laptop computer. During the initial part of the exam she is turned toward the screen inputting the patient's answers to questions into the computer.

"Medicine is constantly evolving," she says, "I'm very interested in new technology. I like hearing about it."

Paz has been in the area for a number of years and is currently one of the practicing physicians at Family Care Associates. As such she is involved in running a business, which becomes a concern in how much time she can spend with each patient.

"We have to see a certain amount of patients a day," Paz says, in order to pay her overhead, which includes the salaries of the members of her staff. "We don't have that much time and it seems like it's always less and less." Alternative practitioners have more leisure because they aren't dependent on insurance to pay the fees, she says, plus they can sell herbs and other nutritional supplements on the side.

Not only is time a constraint on private practice physicians; so too is the amount of reimbursement from insurance coverage and the time lag between filing a claim and receiving payment.

"Patient expectation is that insurance will cover the cost, but they pay less than what is billed," Paz says.

Physicians rely on pharmaceuticals because of patient expectation and the way they're taught in medical school. "Doctors are scientists," Paz says, "We're taught the scientific model. Drugs are tested, tried and true for the majority of people."

Put through rigorous, scientific testing, pharmaceutical drugs have documented results that physicians are familiar with. While herbs are becoming more mainstream, Paz says much of the evidence of their effectiveness is anecdotal.

"A lot of people have made claims," she says.

The physician acknowledges that the Chinese have done extensive studies of herbs, but that Western physicians don't have access to them.

Paz worries that patients accept herbal effectiveness on blind faith and that herbs can have dangerous interactions with other substances.

"I'm not against herbs," Paz says, acknowledging she has taken them on occasion. "It's dangerous to say they're not safe."

She is also concerned that patients self-medicate with herbs without knowing what they're doing or consulting a knowledgeable practitioner. Patients may be taking herbal products on their own that she advises them to discontinue because they may have an unwanted side effect, such as being a diuretic. Also, a person may have a particular allergy to a plant that is used in an herbal remedy.

"We get more cautious in making claims," Paz says. "We treat herbs like medicine--to be used with caution."

The rising cost of modern medical care cannot be blamed on one thing because it's a combination of factors, the physician says, such as medications, medical products, medical equipment and physicians' malpractice insurance. "All that is transmitted to what we charge."

Hospitals are an even bigger source of rising costs. When Paz's aging father needed a short hospital stay, the bill was $75,000. "It was three times the cost of his care. It's outrageous," she says.

"So many factors go into cost of health care and insurance," she adds. "I don't know where to start."

Paz singles out million-dollar lawsuit awards and the greed of some attorneys as major contributors to the problem. No physician should be without malpractice insurance, she says. "If you don't have insurance you're up a creek. Fortunately, I haven't been sued yet."

Alternative health care has had an effect on the way Paz practices medicine and what she recommends. When patients come in to see her, they're asked what over-the-counter medicines they may be on, including herbs. She might be inclined to recommend a massage, acupuncture or a chiropractor. Energy-producing exercise such as yoga can be good for some patients. Occasionally Paz recommends a visit to the health food store for natural plant-based remedies to relieve the symptoms of menopause, or cranberry pills for bladder infections.

To keep up-to-date on new drugs and treatments, Paz says she does read some literature from pharmaceutical companies, but her primary source of new information is medical journals. "We get those all the time," she says. Among those she reads are the journal representing the state medical society and the American Academy of Family Practice Journal.

One of the main issues for Paz is making health care more accessible for Hispanics. Many serious diseases such as diabetes, obesity and heart disease have a high incidence among Hispanics, and that's getting worse. Contributors to the problem are poor food choices and lack of exercise. "Fatter food is cheaper," Paz says, "Vegetables cost more."

Paz has been working with government agencies and the National Hispanic Medical Association to improve health care access.

Culturally, language can be a problem among Hispanics if health care providers don't speak Spanish. Other ethnic groups and the hearing impaired may also not speak English well.

The physician says she has been talking with the legislature to try to make health care communications in any language mandatory. "Any communications barrier is an issue," Paz says.

Jessica J. Savage is a freelance writer who lives in Las Cruces and last wrote for Desert Exposure on hydrogen fuel technology. She utilizes both Dr. Conchita Paz and Deborah Brandt for her health care needs.

 

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