Previously, most research in medicinal plants focused only on isolation,
characterization, biosynthesis, and pharmacology of active constituents
or active principles. It was totally focused on an allopathic (erroneously
touted as the only scientific) approach with the ultimate goal of obtaining
active and effective pharmaceuticals from plant and other natural sources.
No scientists were properly investigating the validity of the traditional
use of these herbal medicines. And hardly any researchers who had knowledge
of traditional herb use had training in modern scientific disciplines.
Consequently, few or none of the reviewers of most journals know how to
evaluate herb research that involves multiple active or unknown active
components. This is exacerbated by the fact that some of these herbal
journals picked reviewers more for political and financial reasons than
for the true expertise of these reviewers. (2) Even if a particular journal’s
board of reviewers does encompass all the appropriate fields of expertise,
it doesn’t mean the papers published in it are necessarily of good
quality. The reason is that most of the reviewers do their review free
of charge as a professional courtesy. And these reviewers often do not
have time to review the manuscripts. Since few, if any, of the editors
are knowledgeable enough in all aspects of herb research, the result is
the current mess of publications in scientific herb research (Issue 18,
pp. 1-2; Issue 23, pp. 1-2).
Examples of papers lacking clarity and basic information abound. They
may meet rigorous scientific protocols in most aspects except the most
important one, on which the whole research was based. This renders the
publication basically useless because its research results can never be
reproduced. I am talking about the most basic element in any biomedical
research (especially in herb research) which is the object of our research.
This is the material which we are investigating – the drug, the
chemical, the device, or the herb. For a conventional drug or chemical,
there is no problem defining its identity and quality, because it is chemically
well defined, which can be readily analyzed. For a device, there shouldn’t
be any problem either, because if it is not the same device with well-defined
features, it is not the same device. But with an herb, it’s a totally
different story. Unless the scientists who study it are trained and knowledgeable
in both the traditional and scientific aspects of it, they won’t
know what the ‘herb’ is that they are studying. And the results
they produce could be interpreted many ways and are of little use to others.
But when these results are submitted in the form of a manuscript to a
‘peer-reviewed’ journal for publication, unless the board
of reviewers has an expert or experts knowledgeable in both the scientific
and traditional aspects of herbs and these experts actually have time
to review them, the lack of definition of this ‘herb’ will
not be detected before the paper is published. There are many papers in
the herbal scientific literature published in reputable herbal, natural
products, and conventional medical journals which are of this nature.
Naturally, since these papers have appeared in these well-known ‘peer-reviewed’
journals, the misinformation promptly entered major databases. Once there,
it is not easy for us to expunge. I suspect a lot of the controversies,
not only in herbal medicines/supplements but also in biomedical research
in general, which seem to see-saw back and forth between positive and
negative findings, are due to researchers’ basing their research
unknowingly on ambiguous published data.
Are
reviewers/editors falling asleep on the job?
There is one well-known publisher, whose name shall remain anonymous,
which has been putting out huge numbers of books in the natural products,
food, drug, and medicines field for several decades. It is a prime example
of how slick and persistent marketing can sell anything, because if you
keep seeing the names of these books in mailings and in ads, it takes
discipline not to buy them, especially if you are not very familiar with
the subject. Since they are from such a well-known publisher, one would
think that they must be good. But that assumption is wrong. I honestly
have tried to give them a benefit of the doubt, but over the past 4 decades
have only found a few that are decent or half decent! Even those I am
not willing to spend my money to purchase, with the exception of one title
that I actually bought a couple of years ago. Before that, I bought my
last 2 books from this publisher in the mid-seventies, when those were
the only books on the subject available. Their poor quality and limited
information prompted me to write my Encyclopedia, which was published
by Wiley-Interscience in 1980, since revised in 1996, and the 3rd edition
currently in the works. My book is by no means without faults, but at
least the errors are relatively minor and there are few bloopers, if any.
Unfortunately, that is not the case with a sizable number of books in
the herbal medicine field, which are marked by their scanty, outdated,
and/or wrong information, as well as poor, illogical presentation. It
appears that reviewers and editors may have fallen asleep on the job,
otherwise how can one explain such poor-quality books emanating from such
prolific publishers like the one mentioned above? One possible explanation
is that these publishers may have been using experts in the wrong fields
to review their book proposals and manuscripts (e.g., a chemist to evaluate
the work of a botanist). The deplorable quality of such a sizable number
of publications may also be the result of publishers’ desire and
haste to capture a portion of the herbal medicine market before they are
technically ready. Another reason is due to journal editors’ bias
and lack of knowledge in the herbal medicine field, which is often a result
of their conventional medical or pharmaceutical training. Here I want
to quote 3 examples of what appears to be the result of “sleeping”
reviewers or editors.
1. There is a recently published book on botanicals used in cosmetics
by the same nameless but well-known publisher mentioned above, which appears
to be another example of reviewers and editors falling asleep on the job.
This reference volume has no substance whatsoever.
2. I don’t seem to be able to leave the “The Complete Guide
to Herbal Medicines by Fetrow and Avila” alone, because it is such
a typical example of editors and reviewers falling asleep on the job.
If any of them were half awake, they would have caught perhaps 25% of
the errors, most of which non-technical editors can easily detect. For
those who have not read my previous reviews of this handbook (Issues 27,
28, & 29), it is one of the worst (if not the worst) books on herbs
I have ever encountered. Yet it is efficiently marketed and sold in major
bookstores, disseminating misinformation. The scary thing is that there
are more than 1 well-known publisher putting out this kind of work!
3. Here is an example that is from another well-known (and venerable)
publisher. It is an article on Panax notoginseng in a respectable journal,
authored by Italian researchers [J. Ethnopharmacol., 73(2000): 387-391].
There are numerous typographical errors, including “hemorheological,”
“notoginsenoides” (notoginsenosides), and “ginsenoides”
(ginsenosides), the last 2 throughout the text. Then, there are also “damarrane”
(dammarane) and “Arialiaceae” (Araliaceae) as well as “ginsenoide
XVII” that does not exist. What they probably mean is gypenoside
XVII that is found in the root of Panax notoginseng. Three other readily
detected technical errors are: (1) wrong author citation of the botanical
name, which requires a parenthesis for Burkill to be correct - Panax notoginseng
(Burkill) F.H. Chen; (2) “notoginsenoides titolation” of which
I have not the foggiest idea, and would appreciate enlightenment from
my readers and colleagues; and (3) the authors have equated polysaccharides
to “notoginsenoides” when describing their immunostimulating
activities, which are due to the polysaccharides, not saponins. Where
were the reviewers when they were so sorely needed?!
Sometimes I feel rather frustrated and alone in this herbal information
field. Why aren’t more of my colleagues concerned about the continuous
publication of research in natural medicines which is often so egregious,
and yet is being abstracted, entered into major databases, distributed
worldwide, and indiscriminately quoted? To my academic colleagues, what
good is your research if your findings are all mixed in with others that
are dubious and downright worthless? Don’t you think it is about
time to do something to arrest this tide of information pollution? Even
as late as 6 or 7 years ago, I might have the same thinking as most other
scientists in this field – not paying too much attention to the
exact nature of the botanical materials we studied or wrote about. But
I have since ‘matured’ in my evaluation of literature before
incorporating it in my writings. I no longer consider abstracts worth
incorporating without caveats, because, unless abstractors have been trained
to recognize whether the original articles clearly identify the subject
materials used in the studies, resulting abstracts don’t give you
any useful information. So, let’s take hawthorn. If “hawthorn”
(not specifically hawthorn leaf, fruit, etc.) or “Crataegus monogyna”
were reported to be effective in, say, lowering serum cholesterol, what
is this “hawthorn?” Is “it” the root, the leaf,
the fruit, a water extract of the root, a water extract of the fruit,
or maybe it could be the leaf, or maybe it was a 70% alcohol extraction,
or maybe a pure alcohol extraction, etc., etc. It is no longer appropriate
to simply say “hawthorn” is good for this and that unless
one is specifically talking about hawthorn berry in its traditional context
where it can be understood to be used in certain traditional ways (e.g.,
tea or decoction). Anything deviating from tradition must be clearly identified
in modern scientific studies, otherwise no correlation can be made between
scientific findings and the herb. The continued sloppy treatment of hawthorn
(or any herb) as if it were a pure chemical drug must stop! This way,
we can start eliminating poor-quality or dubious work from the new literature,
which, in turn, will eventually reduce the confusion in the field of herbal
medicines and supplements. As I have said it before, if we don’t
do something meaningful to stamp the flow of the polluted information
pool soon, the field of natural medicines/dietary supplements will be
drowned in it [Issue 24, p. 3; Issue 27, p. 2].
How
to improve the quality of scientific data on herbs
In order to do this, we have to address the problem at 3 levels: (1) research;
(2) publication; and (3) abstracting, indexing, and data input into databases.
I am not too concerned about basic scientific research technologies. We
all learned those in college and then graduate school, and further honed
our skill in our ‘real’ research jobs. What I am concerned
about is that most researchers who have not been trained in natural medicines
don’t seem to have a feel for the importance of the clear definition
of these materials before using them as objects of research. Although
we have all been trained in the use of good science in our research, we
often ignore it when it comes to herb research. We all know the importance
of applying the right quality control to the research material (e.g.,
a chemical or drug substance) and would never accept one that is not well
defined. For instance, we would never think of investigating the effects
of alcohol on, say, human cognitive function, by using a liquid called
‘alcohol.’ Based on our training, it is almost second nature
for us to clearly define the alcohol (in this case, obviously ethanol,
because it’s not ethical or permissible to use other alcohols on
human experimentation), its concentration, purity (does it contain toxic
adulterants?), etc. We would never accept just any ‘alcohol’
because it is an ‘alcohol’ or close enough, such as methyl
alcohol or isopropyl alcohol. Yet many research studies on herbal medicines/supplements
use test materials that are vaguely defined, if at all. Terms such as
“ginseng,” “echinacea,” “kava kava,”
and “St. John’s wort” have been routinely used alone
as sole description of the test materials used in the studies, in at least
1 of the 3 levels mentioned above. In some of the better-defined (but
still grossly inadequate) materials used, researchers may use the Latin
binomials of the plant species (from which the material is derived), believing
that that would be the definitive proof of identity. However, without
providing which part of the plant supplies the test material, the scientific
name of the plant is meaningless, and the study using this still-basically-undefined
material will produce dubious and meaningless results. For example, again
using hawthorn, how meaningful would the study of “Crataegus monogyna
Jacq.” be? Here we have ‘scientifically identified’
English or one-seed hawthorn. But it has no relevance to the material
under study. Is it the leaf, the seed, the fruit, the flowers, the root,
or a combination of these parts? Also, is it the powdered crude material
(whatever plant part) or is it an extract in water, ethanol (%?), or other
organic solvent? And if so, how concentrated is it? Also, is it standardized
to chemical markers, and which ones? These are just a few variables that
must be clearly defined for resulting data to be reproducible and usable.
Amazingly, many reports still simply use the name of the species (e.g.,
‘hawthorn’ or ‘Crataegus monogyna’) to describe
the materials used in the studies, at least in level 3 and sometimes also
in level 2. No wonder we are suddenly being inundated with so much herb
research data that are dubious or ambiguous and controversial! Which reminds
me of how the use of Latin binomials to define a plant species is only
as valid as the competence of the person who uses it. I used to know a
flavor chemist who was in charge of the laboratories of an extraction
company. He had the Latin binomials of most plant species associated with
the materials being extracted at his plant memorized, though he had no
clue as to how to identify the plant materials other than a few very common
ones used in flavors, such as fenugreek seed, carob pod, chili pepper,
coffee bean, etc. He was quick to put in the Latin binomials on his certificates
of analysis, even though he might have no idea whether the materials extracted
were actually from the plant species he put down on his certificates of
analysis. Yet he was very proud of the fact that he knew the Latin binomials
of plants and followed ‘standard scientific protocol’ when
making his reports (certificates of analysis). To me, this is a typical
case of a theoretical intention that does not always lead to a proper
successful execution. Furthermore, in this case, it gives one a false
sense of security by believing a correctly identified test material has
been used. I suspect this situation is not unique. It probably applies
to many companies involved in herb research and/or manufacture as well
as to academia and other research institutions.
The key to improving the quality of scientific herb research data lies
in the clear definition of the test materials (crude botanicals and different
forms of extracts) used in any research. Currently, there are no official
or universally recognized guidelines (or criteria) for defining such materials.
The late Dr. Varro (Tip) Tyler and I have independently addressed this
issue (Issue 19, pp. 2-3; Issue 35, pp. 2-3).1 In my article, I have actually
provided guidelines for defining these test materials, which can and should
be used at all 3 levels. Those criteria were first published in the March/April
1999 issue of this Newsletter and later reprinted in the November/December
2001 issue. Yet to date, none of the journals in our fields (pharmacognosy,
natural products, phytomedicine, herbal medicine, Chinese medicines, ethnomedicine,
etc.) which should be the leaders in herb research, has set minimal criteria
for defining test materials as conditions in accepting manuscripts for
publication. I just don’t get it. How can my colleagues, who are
publishers, editors, or reviewers of these journals and who are supposed
to be experts in this field, continue to allow the publication of herb
research data that are often not worth the paper on which they are printed?
Furthermore, the longer these publications are allowed to continue to
inundate us with ambiguous and dubious (some egregious) information, the
more expensive and difficult it will be for us to rectify the problem.
Without reliable scientific research data on which to base further research
on botanical medicines or dietary supplements, we will continue to generate
irreproducible, ambiguous, dubious, and, yes, controversial data. And
we will be wasting our taxpayers’ money by continuing to support
such research. The end result would be a declaration by the pharmaceutical
and medical professions telling the world ‘I told you so,’
supported by scientific ‘evidence’ from research sponsored
by our government.
The only way to rectify this whole mess and stop wasting any more money
and energy (first to produce dubious/ambiguous data and then try to deal
with the controversy and more misinformation generated by these data)
is to immediately institute criteria or guidelines for researchers, journal
editors/reviewers, and data entry professionals (abstractors, indexers,
database managers) to clearly define test materials before being accepted
for research, publication, and/or incorporation into databases. These
criteria should be instituted at all 3 levels – research, publication,
and database. To start, they don’t need to be all-at-once comprehensive.
The most urgent need is for these criteria to be there so that professionals
at all 3 levels of the information generation and dissemination chain
will be aware of the futility and wastefulness of dealing with undefined
research materials. The key is to get them to stop equating a natural
test material to a pure chemical drug or a plant species (common or scientific
name), and to start thinking about what that test material actually is
or should be. This will be the only way to ensure that the information
generated from botanical medicine/supplement research has a universally
acceptable level of quality, which scientific researchers from healthcare
and related fields may use with confidence to develop new, credible, and
useful data.
(1) Tyler, V.E., Scientific Review of Alt. Med. 4(2): 17-21(2000).
(2) C.A. Swanson, “Suggested guidelines for articles about botanical
dietary supplements,” Am J Clin Nutr 2002; 75: 8-10.
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