Файл: Medical_Myths_Lies_and_Half-Truths_guidebook.pdf

48

Lecture 13: V

ague Symptoms and Fuzzy Diagnoses

developing a disease. We may slow its progression or even stop it from 
progressing. We may reverse some of the damage or disability that has 
resulted from the disease. We may alleviate symptoms and improve quality 

of life, prevent complications of the 
disease, or prolong survival with 
it. None of those things would be 
considered a cure, but they are all 
tremendously useful.

Let’s continue to examine how 
doctors make diagnoses. There 
are different types of diagnoses: 

There are clinical diagnoses, which are based on having a certain set of 
signs and symptoms. (Symptoms are something the patient experiences; 
a sign is something you see when you examine a patient.) There also are 
laboratory methods, like blood tests and X-rays, of making or con

¿

 rming a 

diagnosis. And when a diagnosis is made entirely by biopsy, we call that a 
pathological diagnosis. 

Doctors also sometimes make what we call a diagnosis of exclusion. You 
have an appropriate clinical syndrome, and we rule out everything else 
that can cause that syndrome. What you’re left with is the diagnosis of 
exclusion—something we know can cause those symptoms, even though we 
may not have any laboratory test to con

¿

 rm it. 

There are many problematic diagnoses, however, that are out there. They are 
less clearly established, more ambiguous, and more controversial. What are 
some of the warning signs of these problematic diagnoses? They tend to be a 
clinical syndrome, not something that is tied to a speci

¿

 c laboratory 

¿

 nding. 

They tend to have common, nonspeci

¿

 c symptoms, such as pain and fatigue. 

Problematic diagnoses also tend to be highly variable in their presentation. 
The symptoms and signs that get attached to that diagnosis don’t suggest one 
cohesive, coherent underlying cause. 

Another problem is diagnosis creep. Once you have a label—a questionable 
label based on nonspeci

¿

 c symptoms without anything very objective to 

verify it—it tends to apply to an ever-expanding list of presentations, with a 

There are multiple ways 
to treat a syndrome or a 
disorder before we completely 
understand its cause.

49

broader and broader scope. In addition, there’s diagnosis expansion, which 
means applying the diagnosis to milder and milder versions. 

Treating these problematic illnesses—when we have only a vague syndrome 
without anything speci

¿

 c to hang our hat on—is also, of course, problematic. 

They tend to be resistant to speci

¿

 c biological interventions and to bene

¿

 t 

only temporarily from treatments that are likely to have a placebo effect. 

I think we’ve covered a lot of information about what doctors think about 
when they’re making a diagnosis. There are a lot of pitfalls and it can often 
be very tricky to make an adequate diagnosis. The approach that we often 
take is to look for things that we know how to diagnose and how to treat. If 
we make a diagnosis, then we treat based on the diagnosis that we make. We 

¿

 nd any contributing factors and essentially treat what we 

¿

 nd. 

But sometimes we rule out all of the known pathological contributors or 
causes of a disease. We’re left with a syndrome of symptoms without a clear 
biological cause, but we have ruled out anything serious or treatable. In that 
case, it’s most effective to then shift our emphasis to treating the patient 
to improve their quality of life. That is very important and should not be 
neglected. We shouldn’t get distracted from treating quality of life because 
of a search for a diagnosis that may not be there or just for the false comfort 
of having a label to attach to symptoms. 

Ŷ

Barbour, 

Lyme Disease

.

Lipson, “Fake Diseases, False Compassion.”

1. 

Do you think chronic fatigue syndrome is a genuine disorder?

2. 

What makes one diagnosis useful and another problematic? 

3. 

Do you think we overmedicalize everyday symptoms?

Suggested Reading

    Questions to Consider

50

Lecture 14: Herbalism and Herbal Medicines

Herbalism and Herbal Medicines 

Lecture 14

The history of herbalism goes back farther than the human species 
itself. Many animals will chew on different plants when they have 
symptoms or infections.

H

erbalism is the appealing notion of using plants to strengthen our 
health and treat medical symptoms, but what does science tell 
us about modern herbalism? You may be surprised to learn that 

modern herbalism is scienti

¿

 c. In fact, the core myth of this lecture is that 

there’s something fundamentally different between herbalism and modern 
pharmacology. They are both part of the same science, which is identifying 
useful substances that have some biochemical effect in the body that can 
be exploited. Herbalism, or phytotherapy, simply restricts its range to plant-
derived substances.

Pharmacognosy is the study of drugs or drug substances of natural origin 
as well as the search for new drugs from natural sources. A lot of modern 
pharmacology derives from the study of the health effects of plants or things 
that are derived from plants. Many modern drugs, for example, themselves 
are plant components. Modern pharmacology, which includes studying 
plants and other natural sources, has a speci

¿

 c  de

¿

 nition. Essentially, a 

pharmacological agent or drug is any substance that has a biochemical 
effect on the body, including the microbes in the body, beyond its purely 
nutritional value. 

In short, herbs are drugs. But in some countries, like the United States, herbs 
are marketed as if they were supplements. They are regulated as if they were 
food or vitamins. Herbs often have many active ingredients. The justi

¿

 cation 

for this is the notion of synergy: that different substances individually might 
not have much of an effect but when taken together have a useful clinical 
effect. There can be synergistic effects in herbs; however, we can’t assume 
that that’s the case. We need to base any such determination on actual 
scienti

¿

 c evidence.

51

It also needs to be noted that 
chemical substances in plants 
or herbs—which are taken 
for their pharmacological 
activity—have the same 
range of side effects and 
toxicities that other drugs do. 
We should not fall into the 
false dichotomy of thinking 
that herbs are fundamentally 
different from drugs. 

What about dosing? One 
of the primary advantages 
to the drug development 
process is that we isolate a 
speci

¿

 c chemical. We can 

then deliver it in amounts 
that are very precisely 
measured. When herbs are 
studied, it turns out that 
many have tremendous 
variations in the amount 
of active ingredients they 
contain. Part of the reason for this is the variation from plant to plant. It’s 
very hard to control for the amount of active ingredients just by using a 
certain amount of the plant itself. 

One thing we’ve learned in the last hundred years or so of doing scienti

¿

 c 

experiments for medical treatments is that, for every hundred or so treatments 
that look very promising in the laboratory, very few of them actually make it 
all the way through clinical research and are shown to be safe and effective 
in people. Sometimes there are in vitro or preclinical data that suggest a 
potential role for an herb, but it isn’t appropriate to extrapolate from these 
preclinical studies to clinical claims.

Because herbal supplements are not regulated, 
their purity and dosing are not guaranteed.

© Hemera/Thinkstock.

52

Lecture 14: Herbalism and Herbal Medicines

Another area of concern is that recently it’s come to light that many herbal 
products are contaminated. Some of them contain other herbs that are not 
on the label. A 2009 study of herbal remedies that were purchased over the 
Internet found that about 20% of them were contaminated with heavy metals 
above safe limits. This included lead, mercury, and arsenic—some as much 
as 10,000 times the safe limits. This 
raises the notion that we need better 
quality control.

Plants are legitimate sources of 
safe and effective drugs. We have 
explored them to discover many 
useful chemicals. Much of the 
low-hanging fruit has already been 
picked, but there is still a lot of research that can be done. There may be very 
effective drugs, treatments, and even herbal preparations out there waiting 
to be discovered by careful research. But herbal remedies today are poorly 
regulated. Herbs need to be recognized as the drugs they are and regulated 
appropriately so that they can be used safely and effectively. 

Ŷ

ICON Group International, 

Pharmacognosy

. 

Samuelsson and Bohlin, 

Drugs of Natural Origin.

1. 

Should herbs be regulated as food supplements or as drugs?

2. 

What does the scienti

¿

 c evidence say about the most popular 

herbal remedies?

We should not fall into the 
false dichotomy of thinking 
that herbs are fundamentally 
different from drugs. 

    Questions to Consider

    Suggested Reading