The SkepDoc

Hazards of Herbal Medicine: Lessons from Aristolochia

BY HARRIET HALL, M.D.

This “Brief History of Medicine” has been circulating on the Internet:

2000 B.C.—Here, eat this root.

1000 A.D.—That herb is heathen.

Here, say this prayer.

1850 A.D.—That prayer is superstition.

Here, drink this potion.

1940 A.D.—That potion is snake oil.

Here, swallow this pill.

1985 A.D.—That pill is ineffective.

Here, take this antibiotic.

2000 A.D.—That antibiotic is artificial.

Here, eat this root.

It seems we have come full circle. The only medicines our ancestors had were herbal medicines. By the 19th century, doctors only had a handful of truly effective medicines that remain in use today, like opium derivatives and quinine. Most of the remedies they prescribed were either useless or poisonous. As scientific pharmacology developed, medical treatment was revolutionized. Today we have antibiotics, anesthetics, birth control pills, insulin, and a wealth of other drugs that our ancestors never dreamed of. But recently it has become popular in some circles to denigrate Big Pharma and call for a return to "Natural" (with a capital N) herbal remedies, in the belief that they are uniformly milder and safer than prescription drugs and just as effective. Sorry, but that belief is demonstrably wrong.

A Mystery Solved

In 1993 the Lancet reported several cases of a kidney disease called fibrosing interstitial nephritis among young women in Belgium. It progressed rapidly to kidney failure requiring dialysis or kidney transplant. The authors investigated and discovered that all these women had attended the same weight loss clinic. The clinic had recently added two Chinese herbs to its slimming regimen. Further investigation determined that the herbal pills contained aristolochic acid (found in Aristolochia species). Apparently Aristolochia had been accidentally substituted for one of the intended herbs. In all, 1,800 women got those herbs at that clinic and 5 percent of them developed kidney failure, and about half of those went on to develop urinary tract cancers. Those are not very good odds.