Issue 25 / 11 July 2011

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

8 thoughts on “Sue Ieraci: What would Hippocrates prescribe?

  1. Sue Ieraci says:

    “you can’t charge a fortune for something that is natural. You have to tamper with it so that you can put a patent on it and sell it at a high price.” says Bruni Brewin above.
    But, if that were really the case, how do you account for the multi-million dollar “alternative” medicine industry. I don’t see too many traditional therapies being offered to the needy for free – it is at least as much a money-making industry as so-called “Big Pharma” – only much less accountable.

  2. Bruni Brewin says:

    The Bible is is based on faith. Smacks of arrogance, ignorance and bias and is very unscientific to boot. A mere 200 or so years ago only 1 in 100 people knew how to read and write. Who wrote the Bible? We were a very suspicious people… Was it written to down-tread the masses to fear for their lives and so keep them under control? I don’t think Hippocrates would necessarily change his mind on all he believed in. Whilst he acknowledged that drastic disease needed drastic action, he would also perhaps argue that the whole herb has minimal side effects. However, you can’t charge a fortune for something that is natural. You have to tamper with it so that you can put a patent on it and sell it at a high price.
    Only Hippocrates’ birth date, birth place and profession are known for certain. Historians accept that he actually existed, was born near the year 460BC on the island of Kos and that he was a famous physician and teacher of medicine. All other biographical information is shrouded by myth. Over the years, many legends arose concerning miraculous healing that Hippocrates supposedly did. It is now difficult to separate these from the fact of what actually happened. As no real biography was available for centuries after his death, those that we have today must be based on many years of oral tradition and are thus unreliable. Another important precept of Hippocratic doctrine was based on “the healing power of nature” or in Latin, vis medicatrix naturae; the body will heal itself if not influenced otherwise. Hippocratic therapy was focused on simply easing this natural process; often the patient was made to relax and recuperate on his own: “rest and immobilisation are of capital importance”. By these beliefs, Hippocrates was reluctant to administer drugs and engage in specialised treatment that could be wrong; generalised therapy followed a generalised diagnosis. Hippocrates also reportedly said: “As to diseases, make a habit of two things – to help, or at least, to do no harm”, “It is more important to know what sort of person has a disease than to know what sort of disease a person has”, “Natural forces within us are the true healers of disease”, “To do nothing is sometimes a good remedy” and finally “Science is the father of knowledge, but opinion breeds ignorance.”

  3. Anonymous says:

    @David De Leacy

    “homeopathy, colour therapy, osteopathy and chiropractic nonsense..”
    “Every thing else is faith healing”
    Lumping all these therapies into the one category smacks of arrogance, ignorance and bias and is very unscientific to boot.

  4. Graham Chaffey says:

    My favourite alternative therapy is psychic healing. You can have psychic healing by email. Now that’s way more accessible than Australian primary care!

  5. Guy says:

    I do not doubt that there are those practitioners who believe in the effectiveness of CAM.
    Similarly, I do not doubt that there are those who do not believe in it but practise it anyway.
    Just look at or to see what I mean.
    Also, examination of the Therapeutic Products Advertising Complaints Register see is instructive in this regard.

  6. The Saint from Elsewhere says:

    I don’t think we have the luxury of choosing to be ignorant about what our patients ingest (or imbide or inject come to that.) We need to know what’s around, what it does, how it interacts with other substances and with “prescribing…” – its rarely necessary to do more than give a qualified endorsement of what the patient already wants to do – I just listen carefully and warn against less safe mixtures/practices. I hope such warnings are more acceptable if I don’t appear to be too disdainful of any other advice the patient is getting.

  7. Dr David De Leacy says:

    The Phelps and Pirotta doctors of the world are actively encouraging the wider population to return to the Middle Ages and even earlier when ‘beliefs’ in nostrums, spirit healing and other nonsense rightly condemned the doctors of those times to be called charlatans. The so-called peak bodies of the alternative ‘medicine’ brigade (oxymoron) are in fact nothing more than fronts for snake oil selling and I believe they need investigation by the ACCC into the ethics and practise of exactly what they are doing. The explosion in homeopathic, colour therapy, osteopathic, chiropractic nonsense, etc since the 1970s in this country is an affront to the rationalism and intelligence of the “Age of Reason” in Western civilisation that brought real medical progress to the world and that lies at the heart of true modern medical practice. Everything else is faith healing. I await the arrival of rattle snake healers next in this country.

  8. Kevin Orr says:

    Are we sure alternative therapies are really harmless?
    Are we sure their placebo effect is not covering some serious ailment that needs investigation?

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