Urban Fringe Pharmacy

Silver River productions have replied to my good friend Zoe Hawes about recent criticisms of their programme ‘Grow Your Own Drugs’, specifically referring to criticisms of some of the content of the first episode and their continuing non-mention of herbalists and herbal medicine. Here it is:

Dear Ms Hawes,
Thank you for your letter and the chance to respond to your concerns about ‘Grow Your Own Drugs’.
Our intention in the series, was simply to make remedies which are already used widely, and many have been used historically in conventional medicine. The programmes are not in fact about medical herbalism, which is a philosophical system involving diagnosis and individualised treatment, and as you rightly say, requires years of study. In the course of our research we did speak to a number of Medical Herbalists and we were grateful for their advice. The Archway Clinic contributed a number of remedies to the book of the series.
All of the recipes in the series were assessed from the point of view of safety by Prof Liz Williamson of Reading University, a qualified pharmacist and leading expert on herbal quality and the interaction of plant based medicine with conventional drugs, who is also an external examiner for one of the UK degree courses on herbal medicine. The programme also stresses that the remedies suggested are only for minor self-limiting disorders.
To answer your comments specifically: we are certainly aware of the school of thought which considers hops to be contraindicated in cases of depression, and in the ‘British Herbal Compendium’ Volume 1, edited by Bradley and published by the BHMA it does indeed say under ‘Contraindications’ that hops are ‘inadvisable in depression’, although it offers no clinical reference in support of this statement. In Mrs Grieve’s ‘A Modern Herbal’, it states that ‘Hops were at first thought to engender melancholy’, and she quotes John Evelyn’s Pomona of 1670; this may be where the idea first came from.

However, this opinion appears to be confined to the UK and not only can we find no scientific evidence for it, there also is no mention in Weiss’s ‘Herbal Medicine’ (Germany) or Tyler’s ‘An Honest Herbal’ (USA). Neither is there any mention in the German Commission E monographs, which are widely used globally as information sources, and where it states under ‘Contraindications’ that there are ‘none known’. It is true that people with depression may not require sedation, but this is true for all sedatives and is related to the fact that depression can make people sleepy – but in such a case, the patient would not need something for insomnia anyway. Furthermore, hops have actually been shown to have potential antidepressant activity in two studies, cited below. We have the full text of these papers but are unable to supply them for copyright reasons.

New insight in the neuropharmacological activity of Humulus lupulus L.
P. Zanoli, M. Rivasi, M. Zavatti, F. Brusiani, M. Baraldi. Journal of Ethnopharmacology 102 (2005) 102–106
The last paragraph of the abstract says:
‘In conclusion this report shows that Humulus lupulus CO2 extract exerts: (a) a pentobarbital sleep-enhancing property without influencing the motor behavior of rats; (b) an antidepressant activity. The same effects were elicited by the administration of the Humulus lupulus fraction containing alpha-acids, which can be considered as the major responsible for the enhanced pentobarbital effect and for the antidepressant property.’
Evidence that the alpha-acids fraction of hops reduces central GABA-ergic neurotransmission
P. Zanoli, M. Zavatti, M. Rivasi, F. Brusiani, G. Losi, G. Puia, R. Avallone, M. Baraldi
One of the paragraphs of the abstract says:
‘When dosed at 10 mg/kg, alpha-acids increased, in the elevated plus maze, open arm entries reducing in parallel those in closed arms. In the forced swimming test, we observed a reduction in the immobility time that could suggest an antidepressant-like activity.’
You may also remember the similar case of St John’s wort, which was formerly described (for example in the British Herbal Pharmacopoeia of 1983) as being contra-indicated in ‘depressive states’, but which is now one of the most widely used anti-depressants.

Regarding the dose of senna, this was taken from Martindale’s Extra Pharmacopoeia and Weiss’s “Herbal Medicine” and we advised people not exceed the dose. In the programme, James says that the dose is 6 pods per 10 ml dose, which is well within the range of 4-12 pods. In addition, the usual method for making the infusion is to soak the senna pods for 12 hours – so at 30mins, as James advocates, the amount of active ingredient extracted will be even lower. We are therefore confident that these quantities are safe; moreover to make it even weaker would be to invite criticism that it is an ineffective product, and this would be detrimental to our philosophy of providing safe but potentially effective remedies. James Wong makes it clear in the programme that the dose should not be exceeded and that viewers must know exactly how to use them. As a safeguard he directs viewers to the website, which has the details of the recipes and advice on how to use them, the Syrup of Figs recipe includes the advice that it should only be taken for few days at a time. This advice is also repeated in the book of the series.
James also makes it clear that viewers should not self medicate without first seeking professional medical advice. This is standard practice for all forms of self-medication, and is meant to ensure that not only has a proper diagnosis been obtained, but that any serious underlying disorder is not missed and that the remedy is appropriate for that condition.
Finally, a programme which intended to bring herbalism and herbalists to the attention of a wider audience would be a very interesting project, but it was not what this was particular series was meant to do. However we feel that our programme will stimulate interest in herbal remedies in general and should encourage people to look further into the subject.

Yours sincerely
‘Grow Your Own Drugs’ Production Team

Very well done Zoe for eliciting a responses, and also well done Silver River, for taking the time to reply and for so eloquently placing your cards face-up on the table. In the case of Silver River, I do acknowledge that your primary concern is to please the people who are commissioning you to make programmes – in this case the BBC – and that this is very likely to influence how you might deal with any direct or implied criticism.

I’m not going to beat around the bush here in my response to Silver River as, to my mind, this letter perfectly illustrates what is going on with herbal medicine in Britain. You have on the one hand highly trained herbalists, who daily practice an effective form of medicine that uses herbs, and who are undoubtedly the leading experts in this part of the world on the use of herbs for any medical application, at whatever level; and on the other hand you have representatives of an aspirational political class timidly attempting to curry favour with their aspirational class peers by conforming to the agenda of a dominant medical memeplex, which daily acts in its own self-interest and against those of patients, and which needs to place itself as the central authority on all matters pertaining to the human body in order to secure central government funding, academic prestige, social status etc. ad nauseum. They probably don’t know they’re doing it, so should perhaps be grateful to me, the Dave Spart of herbal medicine, for pointing it out. (a joke).

The narrative arc of their reply takes us from a position where they simply want to describe remedies that are widely used, to a reassurance that everything is fine because they keep telling the audience they shouldn’t self-medicate without getting a ‘proper diagnosis’ first. In between they quote what they hope will amount to an impressive list of texts and alleged ‘ evidence’ to illustrate some sort of expertise of their own. The overall impression given by the tone of their reply is one of effortless superiority, a sort of shrug from a group (ie. social class) of people who are completely accustomed to the feeling of being right. This is simply a continuation of the quasi-racist cultural posturing expressed within the text of the programme itself (I am a scientist, not some hippy…) which is clearly designed to position the presenter, as a representative of the programme makers themselves, as someone who the audience can trust because he represents the dominant medical memeplex. Indeed, there is an overall characterisation of herbal medicine that runs throughout the text of the programme as something which has been recently reclaimed by science, having fallen into disuse. This is suggested by overt statements to that effect, and by the apparent flaunting of a proprietary air by the scientist – presenter as he wafts through his pristine kitchen/TV studio telling us how it is.

However, a problem arises when you start to look into the evidence they select to support their position. They are, as any psychotherapist would immediately observe, ‘in denial’. Take a look at their response to the hops/depression issue. We are told they are certainly aware of the ’school of thought’ that links hops with melancholia, quoting three text sources, but conclude there is no clinical evidence. Once again, no mention of herbalists and our vast experience of using hops in a modern therapeutic context. And despite James Wong’s statement at the beginning of every programme that there isn’t a lot of evidence about herbs because companies cannot patent them, but that they are highly effective anyway. How do they know? Who are the ghosts that plant this knowledge of herbal efficacy (or, as JW memorably said in last nights prog, ‘effectivity’) into their unwitting minds? Who decides when to believe some piece of bilge written in a book by Varo Tyler, and when to rule out any input from a large group of contemporary experts? Anyway, they then go on to do the sort of thing that people who have very little understanding of science do when they are trying to demonstrate how scientific they are, and quote a few papers where, for example, extracts of hops that are never used by herbalists are force fed or injected into rats who are then drowned but found to not be suffering from depression. Jonathan Swift of Gullivers Travel fame would be having a good old chortle at this if he were around to today. Of course, there is no reason why Silver River would be appraised of the very poor quality of the evidence they quote to support their position, as Prof. Williams is not a herbalist. A good place for them to start would be Jonathan Treasure’s brilliant critique of the German Commission E monographs at http://www.herbological.com/commisione_review.htm. I would strongly urge Professor Williamson, at least, to take a look at this critique.

Anyway, perhaps i am splitting hairs about their presentation of evidence, because whatever they say we are bound to disagree as they are still not acknowledging their debt to herbalists, herbalism, herbal medicine etc. (however you want to dress it up). But lets return to the narrative arc of the letter and look at the internal logic of their reply. Try contrasting their opening sentence: “Our intention in the series, was simply to make remedies which are already used widely, and many have been used historically in conventional medicine. The programmes are not in fact about medical herbalism, which is a philosophical system involving diagnosis and individualised treatment, and as you rightly say, requires years of study”, with the later statement “James also makes it clear that viewers should not self medicate without first seeking professional medical advice”. It is quite clear who they mean when they talk about ‘professional medical advice’. They don’t mean people who are qualified to advise on the use of herbs, whose first priority is patient safety, who are trained in orthodox medical diagnosis to be able to recognise any red-flag conditions that would require referral on to specialist medical services, and who have a very thorough grounding in research methods, assessment of evidence, and quality control in the production of herbal medicines, and any possible herb/drug interactions with conventional drugs – no, they mean people who have never had any training in the use of herbs as medicines, who, like themselves, are unaware of the depth and quality of research, observation, and tradition pertaining to the safe use of herbs over several milennia, but who have one redeeming feature that qualifies them as permission givers – they are sponsored by a ruling class who own and profit from the dominant medical memeplex.

Sorry, Silver River, if that sounds a bit harsh. Its just that you come across as being a bit ignorant. Surely when you decided to make a programme involving herbal medicines you would at some point have encountered a discourse on how holistic health models contrast with the dominant biomedical model? Herbal medicines and holistic practice have largely been excluded from NHS funding and the dominant medical model not because the knowledge has been lost or forgotten, but for thin political reasons, entirely fabricated and supported by vested interests. Herbal medicines are predominantly used, as they have always been used, as part of a holistic therapeutic model. Of course, they are also used, in the context of biomedicine, for specific applications – where, as your programme keeps demonstrating, they are also very effective. In choosing to exclude herbalists, by not mentioning the expressions ‘herbalism’, ‘herbalists’, or ‘herbal medicine’; by constantly repeating the deliberate misinformation on how herbal medicine has been lost in order to reinforce your credentials as the discoverers and new owners of this body of knowledge, you are actively contributing to the discourse, and clearly nailing your colours to the mast.