Sue Ieraci: What would Hippocrates prescribe?

WOULD Hippocrates prefer modern drug technology to herbal medicines? It’s a question that occurred to me at — of all places — a Greek‒Australian law and medicine conference.

The conference attracted an interesting gathering of people from both professions and both countries to the Greek Island of Kos — the birthplace of Hippocrates. We visited an ancient healing place (asclepion) and witnessed a re-enactment of Hippocrates’ oath.

In this context, Victorian GP and an advisor to government on complementary therapies, Dr Vicki Kotsirilos, gave a fascinating presentation about the medicinal plants used by Hippocrates himself.

Dr Kotsirilos is the founding president of the Australasian Integrative Medicine Association (which represents doctors who integrate evidence-based complementary medicine and therapies in their clinical practices), and also acts as a performance assessor for the Australian Health Practitioner Regulation Agency. In her talk, she outlined what was known about active ingredients and efficacy studies.

It was while listening to this interesting talk that the thought struck me — would Hippocrates be surprised that people were still interested in herbal medicine in the 21st century?

Extracts of herbs represented the available pharmacology of Hippocrates’ time. As techniques improved, we developed the ability to extract and purify the active ingredients of plants, eventually developing the chemicals we now call “pharmaceuticals”.

These chemicals, though originally plant-derived, can now be provided in accessible quantities, in purified form and in reliable dosage.

My guess is that, given the choice, Hippocrates himself would have preferred modern drug technology.

And yet, the Australian population is spending more money than ever on herbal and other complementary medicines, while becoming increasingly sceptical about mainstream pharmaceuticals and the companies that make and market them.

Ironically, it is the pharmaceuticals that are held to much greater scrutiny and higher expectations than their herbal competitors.

One of the reasons for this is the purported “safety” of herbal remedies.

Yet, the fact is, a drug’s side effects are a reflection of its activity and efficacy. Any drug that has a therapeutic effect will almost certainly have some unwanted side effects simply because it works. On the other hand, homeopathic remedies are highly unlikely to have side effects. Why? Because they contain no active ingredients.

Why is it, I wonder, that our sophisticated consumer market seems to hold such belief in the area of alternative medicines. Should we be looking at the initial origin of an active chemical, or its efficacy and safety to achieve the outcome we desire with the minimum of adverse effects?

Hippocrates said: “There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance.”

As a scientist, Hippocrates would not have rejected modern pharmacology, but embraced it.

Dr Ieraci is a specialist emergency physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. She also runs the health system consultancy SI-napse.

Posted 11 July 2011

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