Expert and Folk Knowledge
The University of Minnesota's Consortium on Law and Values in Health, Environment, & the Life Sciences sponsors a Lecture Series on Law, Health, & the Life Sciences. The lecturer today was Mark Blumenthal, PhD, of the American Botanical Council. Dr. Blumenthal talked on “Nutraceuticals: Dietary Supplements, Botanical Drugs, and Natural Products—Science, Safety, and Efficacy.�
A major emphasis of the lecture was on the discrepancy between FDA regulatory treatment of drugs and herbal supplements, and press coverage of the results of safety and efficacy studies. The emphasis with drugs is on safety, with adverse reactions after FDA approval getting much negative publicity (see Vioxx). With herbal supplements, most of which have been used safely for decades if not centuries (though ephedra is a notable recent exception), the news media focus mainly on studies that seem to demonstrate lack of efficacy. Blumenthal -- who is clearly an advocate of herbal supplements and phytomedicines -- argues that many such studies are vitiated by inadequate, unstandardized analytical methods.
The lecture raised a number of questions in my mind regarding the way we should think about "public" or "traditional" as opposed to "expert" knowledge in the pharmaceutical domain:
- Should we take long term, apparently safe use of a herbal medicine or supplement as evidence (essentially epidemiological) for safety?
- To what extent should we value lack of risk over benefit (with speculative but unproven risk)? Put another way, what is the status of the "precautionary principle"?
- Would it be worthwhile to undertake detailed chemical and pharmaceutical studies of an active compound in its native biological plant matrix, rather than as a purified compound?
- Should the use of a herbal medicine in another "advanced" country (Germany is the source of many of the marketed herbals) be taken as evidence that it is safe and effective in the United States?
- Is it ethical to use medicines derived from folk remedies without compensating the cultures that were the source of these remedies?
Questions such as these raise many issues of the value of expert knowledge (inside or outside the academy) relative to folk or traditional knowledge. A valid role of public engagement in universities is to subject these issues to the same rigorous scrutiny that we apply to academic ideas, without the presupposition that "our way" is necessarily superior.