Why There is So Little Natural Medicine Research

Skeptics often dismiss and criticize natural approaches to healthcare, claiming that there isn’t evidence to support their effectiveness. Here’s why they’re both wrong and right (for the wrong reasons).

Mainstream critics have been calling natural medicine “snake oil” and “quackery” for years. The essence of this argument is that there isn’t any evidence that natural medicines are effective at preventing or treating illness. Distilled even further, the argument is that there isn’t enough of a specific kind of evidence, the so-called “gold standard”: randomized, placebo-controlled trials (RCTs). The argument is true in a specific sense: there are indeed major structural barriers to conducting this kind of research on non-patentable natural therapies because, unlike the case with drugs, the huge cost of this research cannot be recouped. More fundamentally, RCTs may be inappropriate to determine the effectiveness of vitamins and minerals because the effects are harder to isolate. The mainstream’s insistence on RCTs also ignores the mountains of clinical and other forms of evidence to support natural medicine’s effectiveness. All of this serves to keep natural medicine out of the standard of care, and to keep us, as a nation, hooked on prescription drugs.

One major barrier to studying nutrients and their effects on disease through RCTs is lack of funding. Within the National Institutes of Health (NIH) is the National Center for Complementary and Integrative Health (NCCIH). Out of NIH’s $43 billion budget in 2021, NCCIH received a whopping $154 million—0.3 percent. The situation is similar in other countries. For example, about 0.08 percent of the British National Health Service’s research budget went to integrative medicine.

RCTs cost an average of $600 million, and often much more. Clinical trials of integrative medicine can be even more expensive because effect sizes are often small, which requires large sample sizes, and therapeutic effects may appear only after long treatment periods—both of which add to the cost of conducting RCTs.

This brings us to a fundamental problem. Because nutrients (generally) and other integrative therapies cannot be patented, there isn’t a way for a commercial interest to recoup the astronomical costs of conducting RCTs. Only pharmaceutical companies making drugs, which can be strongly patented, can afford theses costs. This creates a vicious cycle: natural therapies are shut out of medical care because conventional “experts” claim there isn’t high-caliber evidence to support their effectiveness; drug companies can afford this research, and so become accepted as the “standard of care” for disease treatment.

It should also be noted that RCTs are often inappropriate for studying food and nutrients. A new-to-nature drug molecule can be better isolated in its effects, although interactions with other drugs are inadequately studied. Foods and supplements often depend on co-factors. For example, supplemental calcium should not be taken without supplemental K2, D, and magnesium, but isolating it for an RCT would miss that.

Further, consider trying to study something like probiotics in an RCT. Probiotics interact with a person’s gut microbiome—the ecosystem of microorganisms residing in the intestinal tract—in infinitely complex ways. Further, the makeup of individuals’ gut microbiomes is highly variable, depending on one’s diet, environmental exposures, and other factors. Given the complexity of these factors, trying to isolate the specific impact of probiotics on health in an RCT may be extremely difficult.

Here’s another example. RCTs rely on the intervention and placebo being well-defined. This is easier to achieve in drug trials, since drugs are manufactured products—one Lipitor pill will be identical to another Lipitor pill. This is different for supplements. Studies on curcumin have shown that the addition of just 1 percent by weight of piperine can result in a 2,000 percent increase in curcumin’s bioavailability. Even tiny changes in product composition that are within manufacturing quality standards may yield very different effects. For herbal medicines, potency may vary based on variety, cultivation method, place of origin, or time of harvest.

Finally, the very nature of natural therapies is somewhat incompatible with standard approaches to research. The cornerstone of integrative medicine is that treatment is highly individualized and holistic, addressing root causes of health problems. This approach is inherently difficult to study in RCTs, which often require isolating a single variable and determining its effectiveness alone.

The status quo that keeps us hooked on pharmaceutical drugs that treat the symptoms of preventable chronic illnesses must change. The proof of the failure of this paradigm is all around us. We can help change this if we demand that more money is made available for research on natural health modalities.

*article adapted from Alliance For Natural Health