Narrator:
0:01
Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, powered by ENCORE Research Group and hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Dr. Koren:
0:17
Hello again. My name is Dr. Michael Koren. This is part of our Two Doc Talk series and I'm very privileged to have my dear friends and colleague, Dr. Lisa Kirvin Dawes, with me. As I mentioned during our last segment, we were medical students together at Harvard and we've been lifelong friends and do a lot of work, including medical education work, together. And here we are.
Dr. Kirvin:
0:39
Yes, you do.
Dr. Koren:
0:40
Here we are talking about something that Lisa is very passionate about and very accomplished in, which is the concept of using natural remedies and ultimately figuring out best ways of applying this knowledge to her patient population. She practices internal medicine and runs internal medicine in a big hospital in Jamaica as we speak. So thanks for joining us, Lisa, and we left our last segment talking about aether anesthesia the fact that it started out basically as a recreational drug amongst a bunch of nerdy chemists that were discovering new elements back in the 1700s and early 1800s. It kind of came over through the college ranks here in the US, ultimately developed by Dr. Crawford Long and Dr. William Thomas Morton and became really a revolutionary way of doing surgery. And then we talked about a bunch of other examples. So talk to me a little bit more about an example of what you've done in Jamaica with regard to these natural remedies, but particularly how you start to pick doses like how do you get more scientific about your approach, just putting a bunch of sav on versus really being studied and thoughtful about it?
Dr. Kirvin:
1:57
Well, I think in Jamaica, as in a lot of the Caribbean islands and third world countries, we have all grown up using herbs and they will tell you a pinch of this. You mix this amount and you put this amount and they're very specific, like one of the herbs we use or one of the food herbs we use for ulcers. We know that it only works. You have to keep it in the fridge for 48 hours. After that you have to make a new batch. It won't work as well, but this has been actually traditionally handed down and I think if you look back in the day with Digitalis, which is now the Jackson, they used to pinch off a piece of the herb and say take this much every day or you will be in trouble. So they have worked it out, but usually it's passed on.
Dr. Koren:
2:46
Right, and that gets into what we're talking about is how you develop things. So Digitalis is a good example of that. It comes from the Fox Club plant. It was used by Sir Weathering back in the 1700s and it was used initially for edema, which was, of course, a sign of congestive heart failure, and so that was the original discovery. And, if I remember the story correctly and somebody will fact check me on this, but Sir Weathering was a physician who actually learned it from a woman who was practicing herbal medicine back in those. Well, she was even practicing herbal medicine. She was, I think she was like a housewife who was just the, you know, the local.
Dr. Kirvin:
3:27
you know there's usually a woman that's the local healer that people come to for stuff for headaches, mensural cramps.
Dr. Koren:
3:35
It was just like a local woman who turned Sir Weathering onto this idea, and then, of course, he brought it to the next level in terms of development, studying it, and then he realized that it wasn't just the Fox Club, but it was the particular chemical of Digitalis, which is eventually become Digoxin.
Dr. Koren:
3:52
But we pharmaceuticalized it by starting to understand that when you use a plant there may be different concentrations of the active ingredient, which is maybe hard to standardize. And then ultimately, you needed to be able to test the levels of Digoxin in blood to know how to dose these things. And so this empirical concept of just looking at observational data gets you to a certain point. But then you got to transition to more scientific methods by which you are giving people a set amount of the product and then seeing what their levels are. Is that a very simple example? So that would be part of the standardization, of the basic observation. And so I may you know that's sometimes hard to do with some herbal remedies because the cost involved in developing those concepts is prohibitive, but you maybe you can comment a little bit on that.
Dr. Kirvin:
4:47
The problem with herbal remedies that people have been using is sometimes when you take out one chemical, it may be you may need about two or three chemicals working together to get the effect that you want.
Dr. Kirvin:
5:01
Classic exam turmeric is an anti-inflammatory, but you need the circumvent or the black pepper to work with it in order to get some of the effects. There's also other chemicals in it that we think actually boost it as well. So if you're making a drug, then you have to make sure you take all of those into account in order to in order to get the effect that you want.
Dr. Koren:
5:29
Right, so so again, that is one of the discussion points and maybe even attention between just herbal medicine and more traditional medicine, meaning what we do, let's call it organized medicine, and we have advanced organized medicine through structured observation, whereas it's sometimes more difficult to do. An example of that would be statin drugs. So red yeast rice has the basic ingredients of Lovastatin and it's actually interesting. I think, if I remember correctly, Merck, who developed Lovastatin, wanted to get red yeast rice off the market, but they were not successful because that was just a naturally occurring chemical that people had been using. And red yeast rice will definitely lower your cholesterol level.
Dr. Koren:
6:25
It won't do it quite as well as as Lovastatin, because Lovastatin is a pure product, and certainly not as well as the newer stentons like like a torvastatin or a resuvastatin, but it didn't actually work.
Dr. Koren:
6:38
And Lovastatin is an effective therapy and it's been evidence based, proven. But your point would be well, the red yeast rice has other components and maybe those other components are less likely to cause statin side effects. For example this has come up before I've actually had situations where I've had a patient that says I can't take any statins. But I ask them can you take red yeast rice? And they say, yeah, I think I can do that. So I give it to them. It lowers their LDL by 20%. It's not as good as I want, but I'll live with it and they feel like it's a natural product that doesn't cause the muscle aches.
Dr. Koren:
7:11
Now, whether or not that psychosomatic or actual, real, it doesn't really matter, because when we're treating patients we just wanna help them get to their goals and in this case we wanna reduce their LDL cholesterol, which is everybody agrees is a positive thing. But, to your point, we don't know if that patient is truly just projecting the side effects, depending on whether or not it's a pill versus a powder, whatever the preparation is, or there's something in fact different in taking a pure chemical versus a combination of natural factors. And again, the only way you figure these things out is by testing, and that testing probably has not been done as much as it should be done, in my opinion, and how you feel about that.
Dr. Kirvin:
7:56
Yes, I agree.
Dr. Koren:
7:57
Yeah, so talk to me a little bit more about taking your organized medicine training and melding that with some of the traditional therapies that you're exposed to in Jamaica.
Dr. Kirvin:
8:09
Well, I think, when I first moved to Jamaica, a lot of medicines that we have great access to here we don't have there, and so you're gonna decide what you're gonna use to treat the patients.
Dr. Kirvin:
8:25
So, you're gonna use what's available there or what and what isn't. I mean, we have done stuff like with patients kind of handle aspirin, we'll do fever grass tea, which also helps them in the same way. So you learn, you have to learn to combine. What we do try to teach is herbal medicine can cause side effects to it. Just because it's an herb doesn't mean it's totally safe and you have to take that into account with their other medical problems. But you know, I used to do that here while I was in the US as well.
Dr. Koren:
9:00
Oh, has that.
Dr. Kirvin:
9:02
Well, when I was in practice, I always had an interest, because of how I grew up, with using a lot of herbs. I grew up in Jamaica, in the country, so we've always used a lot of herbs, and what happened was, in my practice I realized a lot of patients were using herbs along with their regular medicine. This is like 30 years ago. That's a long time and what I would say is bring them all in and I would look them up and then I would say you can take this one, this one, this one, tell them you can't buy this one, and you can't take this anymore and so I did that for several years.
Dr. Kirvin:
9:38
And there was one of the people who worked for me who wanted to lose weight and got this new Chinese medicine and I was supposed to look it up and it was a very busy week. I didn't get to look it up and they called me on the weekend to say she's in ICU and she had chest pain and I went up to see her and I said you took it. I guess that means you can't take this one.
Dr. Koren:
10:03
All right. Well, that's one way to learn. That's one way to learn.
Dr. Kirvin:
10:06
But so just because it's an herb doesn't mean that it will help you. It may, and I've used a series of herbs with helping pregnancy, so it's always been something that I have been interested in. I just tend to read more about them and what are the medicines they're taking and what the other medical problems are.
Dr. Koren:
10:26
Yeah, so there are a couple of elements to that. One, of course, is patient acceptance. Some patients rather have an herbal or natural remedy versus a pharmaceutical, some people the opposite. But if they're only willing to take a natural remedy, that's what you go with.
Dr. Koren:
10:44
Honestly, I deal with this also. I have plenty of people that come to me as a traditionally trained cardiologist but they don't want to take any drugs. So I have to suppress my first instinct and say well, why'd you come to me I am a doctor that prescribes drugs? So I would think that that may be one of the main reasons you come to me, but of course, there's other reasons. And then, of course, you just get pragmatic. So I also am not discouraging at all about people that want to use herbal remedies, but I do. The same thing is you need to look them up, and a lot of them have stuff in them that you wouldn't want your patients to have or that patients don't even know about. So you know, for example, I get a real kick out of this. You've probably seen this.
Dr. Koren:
11:33
But memory we do a lot of memory research here at our institution and I have patients that come in oh, I saw this product on the internet. That is supposedly great at memory. It helps your memory. There's all these testimonials saying that my memory improved when I got this and this 14,000 testimonies, whatever it is and I said, okay, well, bring it in. So bring it in. And what's the main ingredient? Caffeine, caffeine.
Dr. Kirvin:
11:56
Right, I was gonna think it was ginkubaloba which is the problem.
Dr. Koren:
11:59
Well, they put that in as well, but the main ingredient is caffeine. So, yeah, you know, after a cup of coffee I think I can remember things better than before it, and so that gets into some of the marketing, but also the fact that we don't know that much about these certain things. Like you know, very simply, we all use caffeine to help us with our concentration. You know, at least most people in medicine.
Dr. Kirvin:
12:23
They just keep us awake.
Dr. Koren:
12:23
Yes, yeah, it helps your concentration, we know that. But there's a lot and we kind of figure out individually, like does one cup of coffee do it for you? Do you need two, do you need five, do you need 10? Remember I had one fellow intern in New York who had diet cokes. That was his caffeine source and he knew exactly how to dose it during the course of the day in order for him to keep his concentration going, and he kind of figured that for himself. But we don't know that much about it. More globally, like, for example, when does the trade-off occur when you're taking in too much? And these are interesting elements of research that tend not to get funded because there's no obvious funding source. But get back to this whole concept of quote things that we just discover in nature for our day-to-day lives that have medical implications. So I don't know if you have any other thoughts about that. With regards to your practice in Jamaica, are there things that fall into that category that come to mind?
Dr. Kirvin:
13:30
I mean we use a lot of herbs, just naturallyp eople go into the backyard and actually pick these.
Dr. Koren:
13:36
What kind of problem? Give me a problem that you would go for
Dr. Kirvin:
13:42
Menstrual cramps. There are certain plants that you take as a tea and it helps. Menstrual plant it supposedly helps menstrual. There's stuff for headaches, stuff for fevers, there's a plant that you bathe in for when you have chicken pox or any sort of itching, and stuff that does work.
Dr. Koren:
14:06
What's that called Guaca Guaca Guaca plant? Is it like Guacamole?
Dr. Kirvin:
14:11
Guaca You go to there and you pick some guaca bush.
Dr. Koren:
14:14
And do you know what the active ingredient is?
Dr. Kirvin:
14:16
I don't think it's ever been looked at.
Dr. Koren:
14:18
Really interesting.
Dr. Kirvin:
14:19
I don't think it's ever been looked at.
Dr. Koren:
14:21
And for the antipyretics that you were talking about for fever. It has a salicylic acid undergrowth. Yes, salicylates Interesting.
Dr. Kirvin:
14:29
Which is very interesting because my gardener they called me that he was dying and I'm like I rushed outside and said what happened. He said, oh, I had a belly ache and so I had to mix me some fever grass tea and know it's worse than ever and I'm going that's like having aspirin, like yes, it's worse. Because, he sort of knew it as pain, not differentiating pain.
Dr. Koren:
14:53
Right, right, yes, and also, of course, the bleeding elements that could have been, he could have actually had a bleeding ulcer and making it worse with that. That's actually a great anecdote of how you combine traditional medical knowledge, or organized medical knowledge, with naturopathic knowledge.
Dr. Kirvin:
15:10
But there's a bush practically for almost for every problem in Jamaica.
Dr. Koren:
15:15
All right. Well, hey, we're going to leave this session on that note. There's a bush for every problem in Jamaica. Because, while I'll be down, there next week Podcast.
Narrator:
15:24
Thanks for joining the MedEvidence podcast. To learn more, head over to medevidence. com or subscribe to our podcast on your favorite podcast platform.
