Most health professionals have learned that home remedies are no more than quaint relics of a bygone age. They believe that only pharmaceuticals count as medicine. If the Food and Drug Administration approved a drug, they assume it is “safe and effective.” How could herbs or home remedies compete with real medicine? What if we changed the discussion from home remedies or drugs? to home remedies and drugs!
Home Remedies AND Drugs Don’t Work for Everyone!
People often complain when home remedies do not live up to their expectations.
For example, one reader of this column recently sent us a message about a popular approach:
“A friend and I, both with painful arthritis, decided to try the gin/raisin remedy at the same time. We were very hopeful, but neither of us felt any difference in our pain or stiffness. We are so disappointed!”
We certainly understand the disappointment. Not everyone has had such terrible luck with this particular home remedy.
Here is a very different perspective:
“Foot pain was about to take me out of being a staff nurse and squelch my dream of hiking the John Muir Trail again. A progressive orthopedic physician associate (PA) I saw recommended gin–soaked golden raisins. After five or six days, my horrible pain went away! I was astonished that it was completely gone, not just tolerable.
“I went on an international cruise and couldn’t take any raisins with me. In the excitement, I had forgotten about them, but within four days, the pain returned. Clearly, this is an indicator of physical, not psychological (placebo),effectiveness.
“After returning home, I started eating 9 gin-soaked raisins daily. Now I am back walking to work, working as a staff nurse (on my feet most of the day) and doing the Stairmaster at the Y. Before trying gin–soaked raisins, these were all things that I thought I would have to give up.
“Thanks! The PA said he learned about this treatment from you.”
Home Remedies or Drugs for Common Ailments?
How should we interpret such different responses to a popular home remedy? Over the last few decades, we have received thousands of comments about unconventional treatments for muscle cramps, constipation, lice, nausea, nail fungus and warts, to name just a few.
Many people find such options helpful, but others tell us they do not work. That is hardly surprising. Even FDA-approved prescription drugs don’t work for everyone. In fact, when studies state the effectiveness of a new medication, it is sometimes quite disappointing.
We could look at statins as just one example. Doctors prescribe these medications for tens of millions of people with elevated blood cholesterol. Controlling cholesterol is supposed to help reduce the chance of having a heart attack or dying from cardiovascular disease.
How well do the statins do that? A recent study compared pitavastatin (Livalo) to placebo for more than five years (New England Journal of Medicine, Aug. 24, 2023). Over 7,000 volunteers participated in the research.
After five years, 2.41 major adverse cardiovascular events (MACE) had occurred for every 100 individuals taking pitavastatin. In comparison, there were 3.36 MACE events per 100 people on placebo. In other words, roughly 1 person out of 100 got benefit. Put another way, 99 people out of 100 did not appear to achieve benefit.
This kind of analysis is sometimes referred to as the number needed to treat (NNT). The authors of this study calculated an NNT of 105 over five years. This means 104 people needed to take this drug so that one person could be spared a bad outcome. In this primary prevention study, the statin did not save any lives.
A NNT for Home Remedies or Drugs?
Nobody calculates the NNT for home remedies. There is no incentive to study them because there is rarely, if ever, any profit in such treatments. Recruiting hundreds or thousands of volunteers to study yellow mustard to ease leg cramps would be a labor of love that few, if any, researchers would undertake. Basically, they could not afford to do so.
That is why we do not get upset when a doctor points out that home remedies do not work for everyone. Neither do FDA-approved pharmaceuticals. However, classically trained health professionals, and that includes nurses, pharmacists, physicians, nurse practitioners (NPs) and physician associates (PAs), are usually enthusiastic about drugs and skeptical about herbs or home remedies.
Experience or Evidence of Effectiveness?
We live in a polarized world. That comes as no surprise to people who care about politics. They may be surprised to learn that the same is true in health care. There are physicians who think statins are so valuable they should be put in the water supply…a little like fluoride. There are also physicians who think statins have been oversold and are far less safe and effective than their colleagues believe.
The same could be said of many other pharmaceuticals, including benzodiazepines for anxiety or proton pump inhibitors for heartburn. Many physicians love these drugs while others think that they are overprescribed.
Common Sense and Trial and Error:
This brings us to the question of experience or randomized controlled trials (RCTs)? Our ancestors figured out what plants were safe and which ones were harmful by trial and error. If a plant nourished them, they continued to eat it. Then if they got sick, they told their friends and family to avoid it. If it killed someone, they learned pretty fast that it was poison! Pretty simple, really, although certainly we would not want to accept such casualties today.
If you go way back in time you will discover that Neanderthals used a variety of herbs including ephedra, yarrow and chamomile. Ephedrine is still prescribed for symptoms of mild asthma and the FDA permits ephedrine injections “for the treatment of clinically important hypotension occurring in the setting of anesthesia.”
At specific times of the year, howler monkeys eat certain leaves that have no obvious nutritional value. They do, however, have anti-parasitic activity. These leaves are quite bitter and anthropologists hypothesize that the monkeys learned that eating these plants could relieve their gastrointestinal discomfort. Somehow, they are able to teach this to their “friends” and offspring.
The plant digitalis (foxglove) was described by the botanist Leonhard Fuchs (1542) as a medicinal herb. It eventually made it into various official pharmacopoeias in Europe by the mid 18th century for its pharmacological activity. Doctors prescribed digoxin for congestive heart failure throughout the 20th century and the drug is still prescribed to this day. This was all without the benefit of randomized controlled trials, just observation and experience.
One other example should reinforce the value of common sense.
The People’s Pharmacy Perspective on RCTs:
We love randomized clinical trials. Data obtained from such research are considered the gold standard. But let’s look back to the one of the greatest pharmaceutical discoveries of all time, penicillin! We doubt that the early developers of penicillin relied on RCTs.
They gave their crude antibiotic to 170 patients between 1941 and 1942 (Yale Journal of Biology and Medicine, March, 2017):
“The results demonstrated a remarkable effect of penicillin in combating bacterial infections without any toxic side effects.”
“The first trials of penicillin in the war setting were conducted by Florey in the military hospitals in north Africa in 1942, and showed that penicillin was effective when used on both fresh and infected wounds.”
We suspect that those were “observational” studies.
Not Home Remedies OR Drugs but Home Remedies AND Drugs!
Here is the point of this article. Healthcare should not be either or one modality or the other! That is to say, there are times when an FDA-approved medication is absolutely life saving. Our new and improved antibiotics are marvels of modern medicine. Anesthetics allow for safe surgery. Blood pressure medications help prevent strokes and heart attacks. What’s more, we expect all of these medications to have shown their worth through randomized clinical trials.
But home remedies and herbs also have a place. Ask your doctor what she can prescribe for nighttime leg cramps and you will likely get a blank stare. Although doctors once prescribed quinine pills (plant-derived medicine discovered long before RCTs to treat malaria), the FDA has banned that practice. Consequently, physicians have no FDA-approved treatments for leg cramps.
On the other hand, we have been writing about home remedies to treat this common condition for many years. We even have a scientific explanation for how it works at this link. One example is inexpensive yellow mustard. A teaspoonful at the first twinge of a cramp can often ease the pain and muscle contraction within a few seconds.
Then there is nail fungus. We wrote an article a few years ago titled:
You will be astonished to learn what the prescription drugs cost compared to home remedies. You will also be amazed at how effective the medications are. According to the official prescribing information, after 48 weeks of daily use the complete cure rate was between 15 to 18 percent in study subjects. Read more details at this link.
We cannot prove that home remedies are as good or better than FDA-approved topical anti-fungal prescriptions, but we suspect some may be nearly as effective at a fraction of the cost. Read about them at this link.
What Do You Think?
We would love to hear from you. If you are a health professional, what is your perspective on herbs and home remedies? Do you believe there is a place for such treatments or do you think it is all hogwash and fairy dust? If you are a consumer of health information, do you think the old wives were right, at least some of the time? Is observation and experience still worth something? Please share your thoughts in the comment section below.
And if you would like to learn more about home remedies, why not check out our book published by National Geographic: The People’s Pharmacy Quick & Handy Home Remedies: Q&As for Your Common Ailments? You will find it at this link.