Are herbs evidence-based care?

[Gladiola]

Over email, I mentioned to a HB MW apprentice that I didn’t think herbs were evidence-based. Rather than saying, “Yes, they are!” She replied, “Just because it’s not in the New England Journal of Medicine doesn’t mean it’s not safe.”

OK, but I thought we were striving for evidence-based care as the goal, and the gold-standard of maternity care.

That’s when she attacked with this reply:
“Midwifery is an art not a science. Most of what is taught is being lost because of people like you who demand it be proven by scientists and researchers instead of going back to the basics and realizing modern medicine mostly interferes with birth and rarely is needed to prevent or treat complications.”

Uhhhh, what? My demanding evidence-based care is wrong & is detrimental to the cause of maternity care reform? Uh, what?
So here are my Qs:

1. Is there something wrong with requesting evidence-based care? Is that still the ideal goal?
2. Are herbs evidence-based or not? And if not, why are they considered a good standard of care without evidence?

Thanks

[Mrs.aLifeofReilly]

Firstly, I think that is a very unprofessional response by the midwife and I would probably personally look for someone else just based on lack of professionalism.

Secondly, I don't think herbs could be 'evidence based' based on research/studies because they really haven't been studied in that sense (not enough money to be made with herbs vs. drugs).

I do think that there is enough traditional knowledge and experience of herbs for them to be used safely as an alternative to drugs, but I doubt that there will ever be any quality peer reviewed studies on their safety and effectiveness.

[*MamaJen*]

I agree, I don't think that herbs necessarily qualify as evidence based care, mostly because I don't think there have been large-scale, reproducible studies showing their effectivness. Now, that said, I think they could be -- it looks like, for example, cohash may very well be effective in encouraging labor in some cases, and I think raspberry leaf tea can also have a lot of benefits.
I think there is a ton of anecdotal evidence suggesting these herbs help (I'll add my own -- RRL tea helped eased my BH contractions), but anecdotal doesn't equal evidence-based. It's more like a starting point indicating the need for studies.
The other thing is, it looks like there's very little potential for harm in something like RRL tea, unlike, for example, medically unwarranted inductions.
So I think it's perfectly acceptable for a midwife to suggest that their patient consider using herbal methods, but not positing it as evidence based medicine.

[lalemma]

I would not be comfortable with that midwife. (But I want my care providers to be able to back up what they're stating as fact. I am not comfortable with answers like "This is traditional, stop questioning me.")

One of my midwives was a naturopath. Her health suggestions routinely included supplements (vitamins/minerals) and herbs, but she was always able to say WHY she believed that Herb X was appropriate. There are some (usually small) studies about herbs. If they existed, she knew about them.

For myself - I am totally a big old hippie, and I believe in the body's ability to regulate its own processes. But I am not going to take a powerful herb just because someone insists that it's "natural", not unless they have either research or some really convincing anecdata to back up their point. (Just like I am very skeptical about regular drugs and ask a lot of questions about the how and why.)

[GoBecGo]

That was unprofessional of her. I'm not sure if it's "ideal" to be wanting evidence based care, but it is your RIGHT to want it, and to insist upon it. Perhaps you're a poor fit with this midwife and should look elsewhere?

[jeminijad]

I don't like the midwife's answer, and I agree that herbal medicine cannot be defined as "evidence based" in the Western medical sense.

Just keep in mind that while evidence-based care in obstetrics/childbirth is a very good thing compared with the relics from the 50s that you still find today, if you demand only that type of care, you are also shutting the door to anything that just can't get funded in the current US medical/research climate. Traditional Chinese medicine, herbal medicine, homeopathy etc all fall under this umbrella.

I am comfortable with a different type of evidence, when the potential for benefit is great and the potential for harm low.

[LaurenAnanas]

I see the use of herbs as evidence based in that there are centuries of use with centuries of results. Some herbs have been studied by universities and whatnot (echinacea, ginko, etc...). Also, so many modern drugs are derived from plants and herbs. Plants are full of chemical compounds that affect the body (nicotine, opium, caffeine, etc...).

The problem with "herbs" is that they aren't regulated for potency or for dosing. For example, there are academic studies on traditional herbs, but rarely are those studies done to the point where there are recommended medical doses, and an herb grown on one farm may differ in potency from the same herb grown on another farm. The consumer has no idea and no convient mode of testing. There are also varying modes of delivery that may affect results- powdered in capsules, tinctures, tea, smoking, etc...

The problem with herbs in pregnancy is the same as many other drugs in pregnancy- the ethical problems with double-blind testing, the gold standard of modern medical "evidence." I think Henci Goer addresses the problems of testing in pregnancy in The Thinking Woman's Guide.

That said, I personally believe that some herbs are appropriate for use in pregnancy (I used Red Rasp Leaf tea daily in my last trimester). The herbal products sold
for consumer use are generally weak enough, and herbs with more dangerous compounds are difficult to obtain because they are seen to have less practical use.

And I agree with PP that the midwife's response was a little off.

[umsami]

Some herbs and homeopathic remedies have been studied pretty well--and so for those, yes, I'd say, they do meet the criteria. Often times, the work has been done in Germany and other European countries. But the vast majority, "no". Very few double blind studies, etc.

Now...the use of midwives... that can be said to be evidence-based medicine... going all the way back to Semmelweis!

[mwherbs]

things that don't have "evidence"- drinking water, eating most of the food you eat, the toothpaste you use, has it been proven safe for pregnancy?
in the late 70's early 80's 70-80%of the drugs were plant based-
and lets think about some dietary recommendations that were supposedly evidence based like the use of margarine/hydrogenated oils- notice that those recommendations just vanished , but for a long while that was the studied recommended source of fats to everyone including pregnant and nursing women--- that pretty much illustrates the short sightedness of how testing is utilized and done whole person health is not explored when doing focused studies-
many herbs used in pregnancy and postpartum have been used traditionally thru time and in different cultures for the same purpose- but some have not- things like Blue Cohosh- one herbalist Paul Bergner wrote a research paper on when the use for childbirth was documented and by who, he has enough background education in understanding what texts existed and who/how they gathered their info- he thinks that it was most likely not a dominate or long tradition of NA use he can source the first person to document it interesting read- in any case there are things like berries, or berry leaves that have been used cross cultures over centuries/probably 1000's of years and things like nettles and other nutrient rich wild green plants that are more used as food/spices in daily life in many places in the world- they end up being speciality items in our society because of how we eat rice-a-roni.

on the other hand I would completely support a woman's desire to not use xyz because they do not want to use it- so we don't have to even talk evidence if you do not want to use a plant, a drug or a toothpaste that is up to you...

[umsami]

mwherbs...you make a lot of assumptions not based on fact and which have nothing to do with the OP's post.. thus hurting your own claims.

She's not asking whether or not they are safe during pregnancy, but whether are not they have been studied and proven to do what they (or herbalists) claim they do.

Originally Posted by mwherbs

things that don't have "evidence"- drinking water, eating most of the food you eat, the toothpaste you use, has it been proven safe for pregnancy?

Actually, yes, there has been studies done on the effectiveness of fluoride-based toothpaste in reducing caries. Most recently, a Cochrane report looking at roughly 75 studies on the subject. http://www.ncbi.nlm.nih.gov/pubmed/20091655

And yes... there are studies on preventing dehydration as well as healthful diets as they relate to pregnancy as well.

Here's one on maternal hydration... http://www.ncbi.nlm.nih.gov/pubmed/12452260?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.P ubmed_Discovery_RA&linkpos=2&log$=relatedarticles& logdbfrom=pubmed

Here's one on diet...http://www.ncbi.nlm.nih.gov/pubmed/20102358


In the late 70s and early 80s, 70-80% of the drugs used in the States were not plant based. Many drugs used then, and in use today, were based on discoveries in nature--but they were all synthesized in a lab. No idea where you're getting your stats... but as somebody who worked for a major pharma company, I can assure you that's simply not the case.


There are some studies out there on the use of Blue and Black Cohosh in pregnancy... which is what she's looking for... evidence-based medicine These bring up some serious concerns... blue cohosh....
http://www.ncbi.nlm.nih.gov/pubmed/18204101

According to a survey of midwives in the United States, approximately 64% of midwives reported using blue cohosh as a labour-inducing aid. There are three case reports in the scientific literature that blue cohosh taken at the time of delivery may cause; 1) perinatal stroke, 2) acute myocardial infarction, profound congestive heart failure and shock and 3) severe multi-organ hypoxic injury. There is one case report that blue cohosh possesses abortifacient properties. There is in vitro evidence that blue cohosh may have teratogenic, embryotoxic and oxytoxic effects. In lactation, the safety of blue cohosh is unknown.

Black cohosh..
http://www.ncbi.nlm.nih.gov/pubmed/17085773

Low-level evidence based on theory and expert opinion shows the following concerns with respect to black cohosh use during pregnancy: 1) labour-inducing effects, 2) hormonal effects, 3) emmenagogue properties and, 4) anovulatory effects. During lactation, there is low-level evidence from theoretical and expert opinion of black cohosh having hormonal properties. CONCLUSIONS: Black cohosh should be used with caution during pregnancy, particularly during the first trimester where its purported labour-inducing effects could be of concern, and during lactation. Black cohosh should undergo rigorous high quality human studies to determine its safety in pregnancy and lactation.

[mwherbs]

umsami, well thank you, I have been a complete grouch today and I know I did not do my usual take on herbs- and you have brought up some really good points-including some references I usually give out - the Canadian studies on herbal safety in pregnancy- those abstracts you linked to on the cohoshes and more are available for free- full text if you follow the link on the right hand side of the page---

now I will stay right in that pregnancy/breastfeeding areas when talking about this though- and although yes there are basic studies on toothpaste- controlled studies on safety in pregnancy? and the very small study on water you linked to was not big enough to be evidence - 5 hypertensive and 5 normal women - my over all point is that we do all sorts of things without any evaluation at all- and some are probably less safe than others - as for herbs most are not studied and even if they are who did the study, and did they even do the right thing- there was a study on the use of garlic a while back and what they did was make a water extraction- not use of the whole plant herb and not use of an oil - but water extraction at a level that would not even really flavor your soup- and found it to be not useful for lowering bp, now would that outcome surprise you, but why did they even waste the time or money on proving it was useless when used that way? many herbal studies are done that way though, yet you see drug companies paying for expeditions and plant cataloging in exotic regions in order to find a patientable "active"ingredient(s) in order to make huge profits - the whole Saint John'swort debachale where the studies first shot down the effectiveness because when the "active" ingredient isolated out and increased didn't really do much and yet the whole herb studies were still showing benefit- then back to the drawing board and the studies are ongoing- in the antidepressant area alteast because what is being looked for are drugs that can be reproduced and not use the whole plant -and sure I get it some things have some really bad side effects that I would rather not have - and so would use a drug instead- a drug that had a very long traditional history of midwife use is ergot of rye, as a midwife I have never used and would not want to- how ever midwives processed it or used it in the far past is lost to oral tradition as far as I know and the SEVERE side effects of overall vasospasum-to the degree of loss of circulation and LSD effects to top it off- well Albert Hoffman - developed for Sandos -Methergine the same stuff we use today - his boss had developed a different active ingredient out of some of the basic ergot alkaloids about 20 years earlier but it had really bad side effects so back to the drawing board he came up with Methergine and a few other ergot based drugs. In any case most of the common stuff we use is too common for a drug company to take much interest in and that is where the research money is.
beyond that I think that most evidence relating to labor and delivery- not just relating to herbal but studies about birth in our country are going to be very skewed now-what is the normal background average birthing diad? 1/3 or more having c-sections and add to that even higher numbers if we were to say operative delivery- this is how there is no evidence against the use of epidurals because once you inflate the c-section rate then using an epidural doesn't really change how often a c-section will happen and it won't change how often pitocin will be used- because they are already over-used- you have small studies on the negative effects on breastfeeding babies but no follow through.
so if I use an herb to stop a hemorrhage, and it doesn't work then I have the option of using other things like pit or the "active ingredient" methergine- but as far as nourishing a pregnant mom- with plants that are nutrient rich- well there are some ethano botany studies that survey nutritional values of things- there are probably even some veterinary studies on some of those plants too, but it is not the studies that I would rely on- just like with the promotion of margarine studies can lead you way astray, what do people eat what have people ate that is what I want to know- and that is what I will trust- I ahve some beautiful cook books from different places in the 2 in particular have some commentary and talk about the use of greens many people do not see here in the US -Mediterranean Grains and Greens by Paula Wolfert she traveled around and learned from the women what they make and how they make it, and the other is Wild garlic,gooseberries and me by Denis Cotter (he is in Ireland) I have many others but those are 2 decent starts.
the other thing is that despite tradition or evidence there is always an exception and if a mom does not feel right about something then there is no way that I think I should prove or insist or go against that feeling-

[claddaghmom]

Originally Posted by umsami

mwherbs...you make a lot of assumptions not based on fact and which have nothing to do with the OP's post.. thus hurting your own claims.

She's not asking whether or not they are safe during pregnancy, but whether are not they have been studied and proven to do what they (or herbalists) claim they do.



Actually, yes, there has been studies done on the effectiveness of fluoride-based toothpaste in reducing caries. Most recently, a Cochrane report looking at roughly 75 studies on the subject. http://www.ncbi.nlm.nih.gov/pubmed/20091655

And yes... there are studies on preventing dehydration as well as healthful diets as they relate to pregnancy as well.

Here's one on maternal hydration... http://www.ncbi.nlm.nih.gov/pubmed/12452260?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.P ubmed_Discovery_RA&linkpos=2&log$=relatedarticles& logdbfrom=pubmed

Here's one on diet...http://www.ncbi.nlm.nih.gov/pubmed/20102358


In the late 70s and early 80s, 70-80% of the drugs used in the States were not plant based. Many drugs used then, and in use today, were based on discoveries in nature--but they were all synthesized in a lab. No idea where you're getting your stats... but as somebody who worked for a major pharma company, I can assure you that's simply not the case.


There are some studies out there on the use of Blue and Black Cohosh in pregnancy... which is what she's looking for... evidence-based medicine These bring up some serious concerns... blue cohosh....
http://www.ncbi.nlm.nih.gov/pubmed/18204101



Black cohosh..
http://www.ncbi.nlm.nih.gov/pubmed/17085773

How interesting! Can you post the links on the deaths/strokes from blue cohosh? Would love to learn more about this.

[mwherbs]

if you click on this link- http://www.ncbi.nlm.nih.gov/pubmed/18204101
and then on the right hand side of the page there is an aqua colored rectangle with the words in white FREE FULL TEXT - click on it and it will automatically down load the full pdf file- Dr.JJ Dugoua does a pretty decent job of sharing those case reports and discussing the info- Paul Bergner also wrote and extensive review of the history of Blue Cohosh including looking at the cases reports of the babies who have had problems including the fact that capsules were used - and he discusses why it is most likely a dangerous way to use blue cohosh and will amount to an overdose full text article is here--
http://medherb.com/Materia_Medica/Ca...on_a_fetus.htm

[matthia]

No, there is nothing wrong with asking for evidence based care. And yes, I do still think that is the standard we are striving for, especially when incidences occur like the off-label prescibring of cytotec to augment labour, resulting in far too many preventable fetal and maternal deaths, not to mention all the other trauma that that drug has caused.

I think it's important to base your decisions on standards that you are comfortable. If you want something proven by modern medical standards, that's your right. If you are comfortable with anecdotal or traditional bases for your proof, than that's also fine. I do think your MW's answer was unprofessional and personally would have made me uncomfortable enough to change my care provider.

I do personally belive that many herbs can be effectively used in many situations, not the least of which is pregnancy and childbirth. I do however worry when people make comments like the one your MW made. It is your responsibility as a mother to make the best (and I believe that to be Most Informed) decision for you. Dosage is important in conventional pharmaceuticals. It is equally important in naturopathy. Herbs can harm as well as heal. Simply because something has been used for 1000's of years doesn't mean it's the right thing for you. And unless you are careful, there can be side effects and consequences.

When I asked my MW about Red Raspberry Leaf Tea, she responded that there is some evidence (I didn't ask for sources) the show that RRL can be a useful uterine tonic and help prepare the uterus for labour. She also qualified that statment by saying that because it is a uterine tonic that is also used in naturopathy to help women suffering from ammenorhea (sp?) and to help regulate various other menstrual problems, her safest recommendation is to limit myself to 1 cup a day until 37 weeks, after which 3 or so was perfectly fine.

This is the kind of answer I am comforable with and expect from the professionals I consult.

ETA: I just re-read your questions and realized I kind of strayed form topic in my post. To answer #2, I think people find herbal remedies a good standard of care for a variety of reasons. Some have seen enough evidence around them to support the use in their own lives. Some have probably read what studies are available, regardless of their limits, and found reassurace there. Some may just be of the perspective that natural and herbal is always preferable to laboratory manufactured medicine. I think it is a decision that is up to everyone to make on there own. I do believe that tradition can provide effective proof in some cases, but since most herbal traditions have been lost it's hard sometimes to really know where your information is coming from. I have read several biographical, modern accounts of naturopaths and really, the method in responsible natural medicine is much the same as in contemporary medicine: Once you have a compound you think might work, you have to test it on a large enough group to provide conclusive evidence. I suppose it's a very limited kind of evidence based proof, gained by the individual rather than a social entity or organization at large (ie, the way major research if prooved within various medical organizations and regarded as conclusive even if your doctor didn;t do the actual research).

[Gladiola]

Originally Posted by Mrs.aLifeofReilly

Secondly, I don't think herbs could be 'evidence based' based on research/studies because they really haven't been studied in that sense (not enough money to be made with herbs vs. drugs).

This is actually what I expected the MW Apprentice to say in response, but she didn't. I've read this before & I actually find it a little difficult to accept. So many things are studied that have no money behind them! Look at studies on breastfeeding... who stands to profit from the plethora of evidence on the benefits of BFing? What about studies that show hydrotherapy is effective for reducing labor pain? I even once read of a study, I think in Germany, where women rode a stationary exercise bike in early labor & that was found to reduce their ratings of pain.

The data is out there for so many things! So it's just difficult for me to accept that there are medically-related treatments that are effective, but still lack evidence.

Originally Posted by mwherbs

my over all point is that we do all sorts of things without any evaluation at all- and some are probably less safe than others-

Well, but if we DO have a study that shows a modern medicine is effective, such as pitocin for controlling PPH, then to me, I would want to make sure there is a substantial amount of evidence to support the use of an herb in the place of the medicine. That's the type of thing I'm sayin here. Referring here to herbs to manage a medical problem - not just herbs to help promote overall good health (such as RRL tea to help prepare the uterus at term.)

[Plummeting]

Originally Posted by Gladiola

This is actually what I expected the MW Apprentice to say in response, but she didn't. I've read this before & I actually find it a little difficult to accept. So many things are studied that have no money behind them! Look at studies on breastfeeding... who stands to profit from the plethora of evidence on the benefits of BFing? What about studies that show hydrotherapy is effective for reducing labor pain? I even once read of a study, I think in Germany, where women rode a stationary exercise bike in early labor & that was found to reduce their ratings of pain.

There are studies to show that some herbs are effective, though. Your midwife didn't mention them and I have no idea why, but that doesn't mean they don't exist. As previously mentioned, many of them are not American studies. And yes, it IS money that prevents large scale, controlled studies of the effects of different herbs. Breastfeeding is frequently studied by government agencies, who have a vested interest in finding the best ways to promote a healthy population. Formula companies certainly aren't doing it. Studies on things like hydrotherapy or stationary bike riding in labor are rarely large enough to meet the same standards as those required for drugs, which is what people are looking for before they accept that herbal remedies are safe or effective.

Umsami pointed to a link that gave a whopping THREE case reports as evidence that blue cohosh is dangerous during pregnancy. Can you imagine how many drugs on the market would be pulled if all it took were THREE case reports of something going wrong for a drug to be proven unsafe? The fact of the matter is that our standards for what we are willing to accept in terms of drug safety (or lack thereof) and herb safety (or lack thereof) are completely different. We want our herbs 100% effective with no side effects, but we're happy with our drugs being 70% effective with a few side effects. Because of that, the second we see one thing go wrong that might be attributable to an herbal treatment, studies are stopped, people are decrying the dangers of said herb, the government is recommending no one use it, blah, blah, blah. And yes, that IS because there's no big pharmaceutical company behind it marketing it and redesigning the studies to show that it's actually safe and hiding data when their studies tell them things they don't want to know. (Remember Vioxx? Remember how it took YEARS and a gov't raid in the UK for pharm companies to admit SSRIs sometimes cause suicidal ideation?)

So I think your midwife gave a strange answer, as there are some studies out there to show some herbal treatments are safe and effective and some aren't safe or effective. I also think you absolutely have a right to insist on evidence-based care. My midwives have certainly never told me I ought to depend on tradition or whatever. When they recommend alternatives, they present me with the available evidence and they support whatever I decide to do. I wouldn't want to be cared for by someone who didn't do that. I think demanding evidence-based care is good. I just think that you aren't going to find the same rigorous studies to support herbs that you will to support pharmaceuticals. That's common sense, and yes, the divide exists because of money. It doesn't mean there is NO evidence for ANY herbs. It means it rarely reaches the same level as that available for drugs.

Who do you think is going to pay to get 5000 people to commit to a controlled study on red raspberry leaf tea for shortening second stage labor? The government does not have a vested interest in that like it does breastfeeding. The universities don't have the kind of money to pay for a study that large if it isn't going to be profitable for them. The pharmaceutical companies certainly aren't going to do it, since they can't patent red raspberry leaf. So who do you think will do it, since you obviously think someone will?

[AlexisT]

Actually, NCCAM does fund studies. Don't forget that there is money in herbs. The supplement industry is a big one and there's plenty of money in it. Most herbalists are not growing plants in their yard; they are buying them. (For that matter, not all drugs that pharmaceutical companies sell were synthesized in a lab.)

Talking about whether "herbs" are evidence based medicine is like talking about "medicine" is evidence based. Some herbs are, and some aren't.

I would drop care from a provider who gave me that answer. She doesn't accept evidence based medicine as a valid premise. That's fine if you don't, but if that's what you're looking for, you're not going to get it from her.

[AlexisT]

BTW, you certainly can patent a drug that has been derived from a plant or herb. So pharmaceutical companies are interested in herbs from that angle. They don't want to sell herbs as-is, but they are interested in results because they can lead to new drugs. The profit motive isn't simple.

[mwherbs]

well lets see, there are some problems with pitocin, which is why there are the studies on misoprostol and there is hemabate , and for boggy uterus there is methergine and you know that there is also the use of a pitocin/methergine combo shot- that is given sooner as well and IVs to counteract contracted blood volume - and then things like tying off arteries and balloons that will act like a pressure bandage inside the uterus and


and the situation is complex, in many states including ones that license midwives and even ones that allow for unlicensed practice midwives are not allowed to use drugs to control hemorrhage-

in the wake of good evidence, or tools what kind of care do you provide

midwives start with thinking that everything will be normal and fine and prepare for occasional occurrences but do not assume that everything is an emergency and most of the time you don't even experience the emergency level of things but something more like a sliding scale of either greater or lesser degrees of problems and pretty much our practices prove out the evidence is there that mothers fair better - less, morbidity and mortality- even with the majority of midwives not being able to legally access common medical items -
Well lets see on the front of breastfeeding research- first of all there was a time when breastfeeding was not being studied much and was not supported- you have LLL being formed in the 50's because of little support and not much research as that organization grew they started asking for research and having some success, in addition we also have a population of birth moms who wanted to do natural birth and breastfeeding- lots of wrangling to change medical practices around birth and breastfeeding because breastfeeding was still a common practice in developing countries and infant mortality rates very high= there became many pathways for breastfeeding info to be supported- and yet there is still very non-supportive breastfeeding practices being done in the majority of hospitals across the US- and info that is not being actively pursued- like the small studies that show epidurals interfere with breastfeeding and recommend further study- with maybe 70% or greater of birthing women getting epidurals don't you think the need for understanding what is happening to babies/breastfeeding is there?
the use of herbs in childbirth has to be universal enough and a large enough population in order to get public funding- the Canadian reviews are some of the best you are going to get- there are some books like Aviva Romm's who is a midwife and an herbalist and she may now be a doc too- any way it takes someone who actually knows the field(s) in order to start on putting together studies- several years ago Aviva and Tieraona Low Dog did a survey of midwife practices- similar to what is done with docs and hospitals to see what is being done. This is a long way to come in a short period of time- in the 80's is when Susun Weed published her Herbs for the
Childbearing Year and that is the first modern herbal dealing with pregnancy and breastfeeding and herbs- Jeannine Parvati had written a book Hygieia which puts a great deal of historic info and some personal experience about her journey to finding ways to care for herself and clients that was published a few years before S Weed's book. Since then there have been many others and enough interest in herbs that a PDR was published but many of the herbs used in America are not in the PDR and it was most info gleaned from the Commission E reports. And you have naturopaths who conduct for the most part small studies usually not enough to be evidence. The ethanobotanists, and the pharmagnogsy folks-
I know that you do not want to think that the profit stuff is there but it is and it is on both sides= big companies who sell "popular" herbs will not benefit from negative evidence and big pharm is really looking for something that can be patented- I live near a pharmacy school and have come across starry eyed folks who do great studies on a particular plant and the get a little funding for further research and if there isn't a unique single reproduceable drug to be had then the funding is dropped and most of the time the research sits in a cabinet or drawer somewhere at the U.so the plant may have been studied but the study goes unpublished- because the company who paid for the research does not want it published.
as a personal view I think that midwives should if they are going to use herbs research what they can and know what they are using and if there is any evidence out about the plant- most plants do have a general constituents list-
as far as why a midwife even with pitocin in her bag would use and herb or her hands first- well some of it would be client preference, some of it could be sensibilities, like this is what I learned with and it worked most of the time and I would only want to escalate to a high dose of a medicine if need be, and as I have said before pitocin is not the cure all for hemorrhage, there is some thought now that oxytocin may be at good levels but there are no more receptors so adding a refined anterior-pitutary extract is not going to change the basic problem of the uterus not responding- herbs have complex actions so there is something that may be acting to increase receptors or unbind them and allow endogenous or even exogenous oxytocin to act, and there is usually some vitamin K in green plants so you have that and at this time we really do not have any drugs that are used to expel placental pieces- the long traditional use of angelica is to expel the placenta- now you can use methergine to keep the uterus clamped down- if the mom doesn't have elevated bp or near elevated- but it is not the same action-and actually well before we get there we are trying to work with mom so that she is healthy, well fed and hydrated throughout pregnancy- and that can mean eating nourishing plants in pregnancy as well as toning a uterus and to get some exercise so she is prepared for the work labor can be. in labor mom still needs to be taking in food and drink and emptying her bladder frequently- now this may seem simple but it has big effects because the uterus uses alot of energy when working full on and if a mom doesn't have it to give then you can end up seeing more bleeding after because there won't be much nutrients to be utilized and not enough fluid to move it around quickly, and with a full bladder that alone holds a uterus back from clamping down effectively- the other thing that is cause for blood loss is tearing and pitocin will not help with this type of blood loss at all-

I see since I started this post to when I actually completed it there have been 3 replies all good ones , much clearer and quicker to the point than what I have to say....

[Plummeting]

Originally Posted by AlexisT

Actually, NCCAM does fund studies. Don't forget that there is money in herbs. The supplement industry is a big one and there's plenty of money in it. Most herbalists are not growing plants in their yard; they are buying them. (For that matter, not all drugs that pharmaceutical companies sell were synthesized in a lab.)

NCCAM doesn't spend nearly as much as the pharmaceutical companies do. Obviously there is money in herbs, but it isn't like Merck patenting one drug and being the ONLY company to rake in 500 million in profit for it over the next few years. If the government were spending as much to research herbs as the pharmaceutical companies are to develop new drugs, then it would be a valid comparison.

Talking about whether "herbs" are evidence based medicine is like talking about "medicine" is evidence based. Some herbs are, and some aren't.

I would drop care from a provider who gave me that answer. She doesn't accept evidence based medicine as a valid premise. That's fine if you don't, but if that's what you're looking for, you're not going to get it from her.

I agree with all of that.

BTW, you certainly can patent a drug that has been derived from a plant or herb. So pharmaceutical companies are interested in herbs from that angle. They don't want to sell herbs as-is, but they are interested in results because they can lead to new drugs. The profit motive isn't simple.

That aspect has already been mentioned in this thread. However, the profit motive is a lot simpler than you make it out to be. Pharmaceutical companies, if they find that an unpatentable herb has a therapeutic effect, do not do long term, controlled studies on that whole herb and then release the reports so that the public can use that information in making health care decisions. Rather, they keep their data to themselves and attempt to discover which ingredient(s) they can isolate and then patent. So the profit motive is actually very straightforward in that case, and neither you nor I nor anyone but their researchers will ever know exactly what effects they found from the whole herb and be able to use that information to make decisions or to decide whether the use of herb X in situation Y is evidence based or not. That's pretty simple.