Public health issues about Chinese herb

The Chinese herb disaster also raises issues for both public health authorities and our Western society.

First of them is the place of alternative medicines, including traditional Chinese medicine in a society driven to expect from medicine not only cure but total happiness. On the one hand society is ready to try medicine before a mediatico-popular jury on the basis of rumour or dubious consumer magazines reports, rather than pay attention to the painstaking, though probably less appealing, double-blind studies involving thousands of patients. On the other hand the same society nurtures therapeutic approaches devoid of scientific basis, including acupuncture, herbal treatment, heat therapy and therapeutic massage.

This tolerance has even gained access to distinguished medical journals: in the Canadian Medic Association Journal, a freelance writer explain very seriously that Western philosophy 'believes that humans are quite separate from nature' whereas in the East 'human body and mind and their environment are approached as a whole'. The alternative medicines derived from the latter philosophy, she continues, although derided by the medical establishment are, fortunately, much better accepted by 'allied health professionals such as nurses and physiotherapists' who are more open-minded about these less well-known health cure options such as traditional Chinese medicine.

The Chinese herbs disaster emphasizes the medical profession's constant responsibility to remind the gen-
eral public that the cornerstone of 20th Century medicine and its success remains the critical evaluation of
every therapeutic modality. As La Bruyere aptly put it more than three centuries ago 'Quacks' recklessness
and their gloomy successes give credence to medicine and to physicians: if the latter let die, the former kill'.
The establishment of an office of alternative medicine as part of the NIH in 1991 to evaluate alternative
medical practices is a first step in the right direction. Western medicine relies on a critical evaluation of both benefits and side-effects of accepted drugs. The therapeutic efficacy of various Chinese herbs is often
wanting. Although it has been suggested in some indications such as adult atopic dermatitis, it rests for many others on broad, undocumented statements derived from the so-called century-old wisdom of Chinese medical practice. Needless to say that ancient Western European medical wisdom has claimed similar
benefits for the now long abandoned practices of bleeding and cathartic enemas. In the case of CHN no documented evidence supports the claim that the two ncriminated herbs have any slimming effect. More
insidious is the widespread belief that herbal remedies are devoid of side-effects; it is derived from the myth
that nature is beneficent.

The lack of official regulations on herbal remedies in many countries stems from this illusion: 'natural
products' are expected to be harmless; phytotherapy appears thus preferable to conventional medicine. The
public should be reminded that most poisons utilized from Greek antiquity (Socrates' hemlock) until more
recent times in Africa and Asia are derived from plants. Similarly many of our most potent (and dangerous)

drugs from digoxin to cyclosporin originate from plants. The Chinese herb nephropathy as well as the
many diseases originating in herbal remedies draws the attention of public health authorities to the necessity
to submit these substances to the same scrutiny as common drugs prior to their release for medical use.Lastly, the fact that an error in the delivery of the herbs is probably the cause of the CHN epidemics
emphasizes the need to implement a rigorous control of the composition of herbal remedies. The ordeal of

our patients would be completely wasted if drastic steps are not taken in these areas.
Our observations clearly demonstrate the aetiological role of toxic compounds in the genesis of renal inter-
stitial disease and in the development of malignancies. The hypothesis that kidney disease as well as some
carcinomas are caused by as yet unrecognized toxic substances has already yielded important insights into drug-induced nephropathies and analgesic-induced nephropathy with urothelial tumours etc. Many more
are yet to be discovered. Only tedious, unglamorous, and undramatic detective work will sometimes uncover
case of identity' the clue that breaks open a case. In A the dumbfounded Dr Watson says 'You appeared to
read a good deal upon Mrs Sutherland which was quite invisible to me'. Sherlock Holmes replies: Not
invisible but unnoticed, Watson. You did not know where to look and so you missed all that was important.

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