Scientist uses retirement to build herbal medicine critique

Posted: Sunday, December 30, 2001

   Americans spend an average of $7 billion a year on herbal medicines. Ginkgo is touted as a remedy to memory loss. Kava kava serves as a sedative. Saw palmetto is considered as good as prescription drugs for enlarged prostate. And black cohosh is good for hot flashes.

   But what U.S. doctors and herbal drug manufacturers don't know about the natural products their patients consume would fill a book.

   That's where Athenian Balwant S. Joshi comes in. A native of Dharwad, India, who grew up largely outside the care of Western medicine, Joshi made a distinguished career of researching the chemistry of medicinal plants, working with the likes of Nobel Prize winner Sir Alexander Todd, who coupled his pioneering work at Cambridge on nucleic acids with a scientific interest in the chemical compounds in cannabis.

   A researcher for 18 years at the University of Georgia Institute for Natural Products Research, Joshi is devoting his retirement years to compiling a critical appraisal of herbal drugs that is among the first texts weighing the existing science behind the alternative remedies, conducted largely by countries outside the United States.

   The study, published by the Swiss scientific series ''Progress in Drug Research,'' shows the usefulness of seven common herbal drugs and the scant amount of scientific research on them, and could help prod the American medical establishment into throwing its considerable weight behind the scientific study of herbal medicine.

   ''If something is useful, you should spend the money and effort and time to see if it's doing any good for the patient -- the government should fund it, the hospitals should accept it,'' he said. ''Anyone who wants to sell it should be able to do it with a good conscience.''

   Joshi's review is one piece in a much larger puzzle. The study of alternative medicine got a boost last spring when the San Francisco-based Bernard Osher Foundation awarded a $10 million grant to Harvard University for the establishment of a center to study the efficacy, safety and scientific mechanisms behind herbal medicine, acupuncture and other health remedies.

   Harvard's center will join a growing list of such university centers studying botanical medicines. The National Institutes of Health is considering promoting the limited study of ayurvedic, the ancient Indian system of medicine, in American medical schools, a curriculum change that has long been advocated by American health guru Andrew Weil.

   Also, the federal Office of Alternative Medicine, created in 1993, has been funding several ongoing studies of herbs and dietary supplements, though the agency's work has been going too slowly to satisfy alternative medicine proponents and has not yielded results from any large scientific trials.

   Joshi's review, conducted with Clark Atlanta University colleague Pushkar N. Kaul, looks at some of the most promising and commonly used drugs: Ginkgo, St. John's Wort, black cohosh, guggulu, kava kava, ginger and garlic.

   His report details all the promise of unregulated drugs such as ginkgo, while chronicling the negative effects they have in some cases. Beyond serving as an aid to memory, ginkgo, for example, might have anti-cancer properties, but some formulations of ginkgo have been shown to complicate surgery and to hamper the body's acceptance of newly transplanted organs.

   Such problems are then trumpeted in news headlines, casting further doubt on alternative medicine, he said.

   ''There have been a lot of contraindications -- of kava kava, of ginger, even garlic tablets. My point is not enough time and money has been spent to investigate natural medicines.''

   Indians have been using herbal medicines for thousands of years under the traditional ayurvedic system, utilizing thousands of plants from Indian forests as one part in a comprehensive health treatment system that includes prayer and relaxation techniques. Joshi brought his knowledge of scientific methods to bear on the ancient treatments when he began work in the 1960s screening plants of the Indian folkloric system for a new Swiss-backed Bombay firm, the CIBA Research Centre. The Swiss had been intrigued by a recent breakthrough in blood pressure medication, created by isolating and purifying a compound of Rauwolfia serpentina, called snakeroot.

   ''They didn't have any interest in India except in this information,'' said Joshi, smiling.

   But they spared no expense setting up the lab, where he spent 20 years screening thousands of plants and passing information on the chemical structures of plants he gathered to biologists, endocrinologists and other specialists. Few of the compounds purified at the lab and others set up in the 1950s and 1960s went on for clinical trials, though Taxol and other anti-cancer drugs were products of that fruitful period of inquiry.

   ''When you have a plant it's a mixture of maybe hundreds of compounds,'' he said. '''You usually you try to isolate them, purify them. You want to have it be reproducible,'' he said. ''Secondly you want to have a hold on the patent and sell it.''

   That's the Western way. What Joshi and other herbal drug proponents would like to see is a blending of Western and Eastern techniques, though he and herbal proponents admit such a synthesis would be difficult, given the ancient Eastern focus on combining several plants, with their hundreds of interacting compounds, into one effective treatment. However, he believes the systems will merge, once Western pharmaceuticals bow to the overwhelming market forces, and lend badly needed scrutiny to the science of botanical medicines.

   ''St. John's Wort has been catching on so fast,'' he said. ''The reasons are quite obvious. Many people are fed up with taking Prozac and the side effects. Why it gives you better relief, I don't know. The clinical trials (outside the U.S.) seem to show that there are some good things coming out of St. John's Wort.''

   ''There are a lot of people who would not like (these drugs) to come out,'' and are quick to unfairly highlight side effects of the unregulated drugs, he says.

   However, his text should put the problems into the proper perspective for doctors, while presenting the promise of botanical medicines in a scholarly fashion.

   ''I believe health comes not purely with modern medicine but with integrated medicine. Good health is not a quick fix, which the present modern medical system tries to do. What (medical knowledge) you have acquired over the generations should not be totally rejected.''



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