The Pill Book Guide to Natural Medicines
A review of the book, The Pill Book Guide to Natural Medicines.
The Pill Book Guide to Natural Medicines, by Michael T. Murray, ND (Bantam, 2002, 1074 pages, softcover) bills itself as having “complete information on more than 250 popular natural health aids plus natural remedies for over 70 common health conditions, from acne to varicose veins.” I happened to see the book in a supermarket check-out line, and picked it up because psoriasis appeared in the index. And while I cannot review the entire book to see how “complete” it is, I can review the information provided in regard to this disease.
Michael Murray is a Naturopath, and claims to have built a database of over 50,000 scientific papers on “vitamins, minerals, nutritional supplements, herbs, and other natural products.” With this database, and through this book, he is attempting to put together a comprehensive guide to what “natural medicine” can do for people. Again, whether or not he’s acheived this goal throughout the book, I cannot say. I believe he fails in a few important ways in relation to his information about psoriasis.
In general, Dr. Murray’s book is completely lacking in supportive references. I didn’t see a single citation for any of the “studies” he mentions. While such things would have made the book much thicker than it already is, they’re quite necessary for those of us who wish to dig more deeply than the book allows. Dr. Murray, of course, wasn’t “targeting” an audience full of people like me, however, and has published a popular-press book instead of peer-reviewed medical articles.
The “unique A-to-F rating system” seems as though it’s biased towards presenting a rosy picture. Most people who are familiar with the A-to-F grading system in American schools understand that a C grade is average. This would imply that Dr. Murray’s C grades for efficacy would be for substances which showed “so-so” performance during tests. No. He states that a C means “Strong historical use or scientific rationale but no clinical trials to show effectiveness in humans.” If it were me, a complete lack of evidence would have rated a D or an F. But any positive clinical trial results appear to mean that Dr. Murray gave a substance at least a B-minus.
Dr. Murray also apparently neglects to differentiate between double-blind, randomized, placebo-controlled clinical trials (the true “gold standard” of scientific medical testing) for which the results are published in a peer-reviewed medical journal, and those for which the results are published anywhere else. The peer-review process is designed to overcome methodological shortcoming which might effect the results of a test. While it isn’t perfect (what is?), a study which appears in the Journal of the American Medical Association can be “trusted” more than a study which appears in Joe’s Medical Journal. Dr. Murray understand the difference (I hope), but appears to ignore it, giving a higher grade to, for example, milk thistle, than would be indicated by a search of Medline (a database of peer-reviewed medical journal articles).
I’ll start with the section about psoriasis. All of the sections on various diseases are gathered together in Section VI— Common Health Conditions, starting on page 851. The section on psoriasis runs from page 1024 to page 1027.
Dr. Murray does fine (in a general sense) for the first two paragraphs (“Definition” and “Signs and Symptoms”), but then he begins to describe the cause of psoriasis. Contrary to what he writes, psoriasis is not caused by a “pileup” of skin cells. That is simply the most-obvious symptom of the disease. He goes on to say that psoriatic skin cells divide 1,000 times faster than normal skin, a rate far beyond that suggested by National Psoriasis Foundation. He acknowledges a genetic component to psoriasis, but also says that several other factors “appear to cause or contribute” to the disease. He offers no supporting evidence for any of them, but I’ll give him alcohol and stress as widely recognized. The ones which aren’t are: incomplete protein digestion, bowel toxemia, impaired liver function, and excessive consumption of animal fats.
Then there’s a section labelled “Dietary Factors.” Dr. Murray writes, “Limit the consumption of sugar…” Why? He doesn’t say. He suggests increasing intake of high-fiber foods because “…fiber helps bind gut-derived toxins that otherwise can be absorbed and trigger psoriasis.” If your psoriasis is triggered by those unidentified “toxins,” then perhaps this will help you, but there’s no way to tell beforehand, and if your psoriasis improves after trying this advice, it may not be due to the fiber.
Dr. Murray then talks about animal meats and fats. He suggests limiting them, in general, but increasing the amount of cold-water fish in the diet (fish are, of course, animals, and they contain fats). He states that psoriatics make more leukotrienes than normal people, and that leukotrienes are made from arachodonic acid (AA), which is only found in animals. AA is necessary for human life. It is not only the basis for leukotrienes (which Dr. Murray, for unknown reasons, calls “toxic”), but many other compounds, as well. Studies on the effects of dietary fish oils in psoriasis go back to at least 1986, and offer conflicting results (fish oils— or similar non-AA substances— given intravenously do much better, but that’s not what Dr. Murray is talking about).[1-6]
Then: eliminate alcohol. A fairly good suggestion, but “…it increases the absorbtion of toxins from the gut that can stimulate psoriasis” is a completely unfounded reason for doing so. It’s more likely that alcohol simply increases the production of inflammation-inducing chemicals, and since psoriasis is an inflammatory disease, it can become worse under such conditions.[7]
And last, under “Dietary Factors,” Dr. Murray recommends an elimination diet as for food allergies. On this point, I mostly agree, but I don’t believe his methodology is appropriate for psoriasis. An outline of my suggestions for people who believe their psoriasis responds to their diet can be found on Flake HQ.
Dr. Murray next has a section labelled “Conventional Drugs.” This section does little but demonstrate his ignorance of the wide variety of pharmaceuticals available for psoriasis. He mentions methotrexate, a few retinoids, Dovonex, and coal tar, and then spends three-quarters of a page listing a boatload of steroids, some of which are far too powerful for use in psoriasis (too risky). That’s it. Despite a copyright date of 2002, Dr. Murray fails to mention UV in any form, or a few other broad classes of medications. For this reason alone, Dr. Murray’s knowledge of psoriasis and how to treat it properly (naturally or otherwise) should be called into question.
Dr. Murrary then lists the “Natural Medicines” for psoriasis, and follows it up with a “Commentary” which provides no information that wasn’t in the “Natural Medicines” section already (except for a dosing suggestion, but it’s not possible to say whether it’s for capsaicin or any of the other things he mentions). The things he suggests are:
Aloe Vera (topical) (pages 831 and 832): Dr. Murray talks about one study which claimed that 83.3% of the test subjects were “cured” of psoriasis. However, the abstract specifically says that “cured” meant “a progressive reduction of lesions, desquamation followed by decreased erythema, infiltration and lowered PASI score,” and not a PASI score of 0, which is what a patient would think of when hearing the word “cured.”[8] For some reason, despite this study, Dr. Murray only gives aloe vera a B for effectivness, when it clearly deserves a B+ on his own rating scale.
Berberine-Containing Plants (pages 539 to 543): Dr. Murray’s only remark about these plants in relation to psoriasis is, “Berberine-containing plants, particularly Oregon grape root, have a long history of use in psoriasis, both orally and topically.” Despite a handful of published research into possible mechanisms (lipoxygenase inhibition, primarily)[9-12], I was unable to find any clinical trial abstracts showing the effects of berberines on living human beings, so Dr. Murray was quite correct in giving berberines a C for effectiveness, under his grading system.
Capsaicin (topical) (pages 834 to 836): Besides the study Dr. Murray mentions[13], there have been at least three other studies done on the use of capsaicin for psoriasis.[14-16]. Nothing to note, otherwise, since capsaicin may very well help reduce psoriasis symptoms. It’s no miracle drug, even if it is natural.
Chamomile (topical) (page 837): Dr. Murray gives chamomile a B for effectiveness against “dry, flaky, irritated skin,” and an A for safety, but then talks about what “may” be true for psoriasis. In other words, when it comes to this disease, he leaves the realm of facts in favor of speculation. Strangely, within the section on psoriasis (page 1027), he gives chamomile a B+ for effectiveness, and a B for safety. There is not a single peer-reviewed article (much less clinical trial report) on the use of chamomile for psoriasis, so he should have given it a C (at best!) for efficacy, and an “unknown” for safety (which isn’t possible under his rating system, but it should be).
Fish Oils (pages 318 to 326): See above for introductory fish-oil material. Dr. Murray, in the section on Fish Oils in the book, cites a study in which “an impressive 77 percent of the patients reported either excellent, moderate, or mild improvement.” A typical study for a topical steroid would show 77% of patients having excellent improvement, alone— so to say, in effect, that 77% of patients had some unspecified amount of improvement is fairly pathetic. Dr. Murray doesn’t provide nearly enough “clues” for me to be able to track down this “impressive” study. There have been many tests, however, and they often show conflicting or equivocal results. One study showed, for example, that after eight weeks of fish oil supplementation, there was no change in how the psoriasis symptoms looked, despite measurable changes to the fatty acid composition of the skin.[17]
Glycyrrhetinic Acid (topical) (pages 838 and 839): Dr. Murray claims that glycyrrhetinic acid (GA) has been shown in “several studies” to be “superior to topical cortisone.” The paragraph implies this is true for “eczema, contact and allergic dermatitis, and psoriasis,” although it isn’t possible to say for sure. There is only one clinical trial of GA and its use in psoriasis, and all the abstract says is that GA can “poteniate” topical steroids[18] — a finding mentioned by Dr. Murray only in passing. As far as I can tell, no reputable study has ever been done on GA’s effects alone against psoriasis, making his B rating little more than wishful thinking. And while GA might be safe, topically, he mentions that it comes from licorice, a slightly risky substance to eat (and Dr. Murray knows this, see pages 735 and 736).
Milk Thistle (pages 741 to 745): Besides a monograph
from the Alternative Medicine Review (oddly, the monograph’s web page is titled “Kava Kava”), there is no indication in the peer-reviewed medical literature that milk thistle has any effect on psoriasis. And the information presented in the monograph is speculative, at best, as is Dr. Murray’s suggestions that milk thistle might inhibit proinflammatory cytokine creation, or help psoriasis by improving liver function, when there’s no evidence that a bad liver has anything to do with the cause of this disease.
and Sarsaparilla (pages 788 to 790): The only clinical trial I’m aware of testing sarsaparilla against psoriasis was conducted in 1942, and it was an open study, without blinding. According to Linda M’s research, sarsaparilla is just another antiinflammatory, and Dr. Murray’s unsubstantiated speculation about “gut-derived bacterial toxins” is probably just wrong.
Berberine-Containing Plants (pages 539 to 543): Dr. Murray’s only remark about these plants in relation to psoriasis is, “Berberine-containing plants, particularly Oregon grape root, have a long history of use in psoriasis, both orally and topically.” Despite a handful of published research into possible mechanisms (lipoxygenase inhibition, primarily)[9-12], I was unable to find any clinical trial abstracts showing the effects of berberines on living human beings, so Dr. Murray was quite correct in giving berberines a C for effectiveness, under his grading system.
Capsaicin (topical) (pages 834 to 836): Besides the study Dr. Murray mentions[13], there have been at least three other studies done on the use of capsaicin for psoriasis.[14-16]. Nothing to note, otherwise, since capsaicin may very well help reduce psoriasis symptoms. It’s no miracle drug, even if it is natural.
Chamomile (topical) (page 837): Dr. Murray gives chamomile a B for effectiveness against “dry, flaky, irritated skin,” and an A for safety, but then talks about what “may” be true for psoriasis. In other words, when it comes to this disease, he leaves the realm of facts in favor of speculation. Strangely, within the section on psoriasis (page 1027), he gives chamomile a B+ for effectiveness, and a B for safety. There is not a single peer-reviewed article (much less clinical trial report) on the use of chamomile for psoriasis, so he should have given it a C (at best!) for efficacy, and an “unknown” for safety (which isn’t possible under his rating system, but it should be).
Fish Oils (pages 318 to 326): See above for introductory fish-oil material. Dr. Murray, in the section on Fish Oils in the book, cites a study in which “an impressive 77 percent of the patients reported either excellent, moderate, or mild improvement.” A typical study for a topical steroid would show 77% of patients having excellent improvement, alone— so to say, in effect, that 77% of patients had some unspecified amount of improvement is fairly pathetic. Dr. Murray doesn’t provide nearly enough “clues” for me to be able to track down this “impressive” study. There have been many tests, however, and they often show conflicting or equivocal results. One study showed, for example, that after eight weeks of fish oil supplementation, there was no change in how the psoriasis symptoms looked, despite measurable changes to the fatty acid composition of the skin.[17]
Glycyrrhetinic Acid (topical) (pages 838 and 839): Dr. Murray claims that glycyrrhetinic acid (GA) has been shown in “several studies” to be “superior to topical cortisone.” The paragraph implies this is true for “eczema, contact and allergic dermatitis, and psoriasis,” although it isn’t possible to say for sure. There is only one clinical trial of GA and its use in psoriasis, and all the abstract says is that GA can “poteniate” topical steroids[18] — a finding mentioned by Dr. Murray only in passing. As far as I can tell, no reputable study has ever been done on GA’s effects alone against psoriasis, making his B rating little more than wishful thinking. And while GA might be safe, topically, he mentions that it comes from licorice, a slightly risky substance to eat (and Dr. Murray knows this, see pages 735 and 736).
Milk Thistle (pages 741 to 745): Besides a monograph
from the Alternative Medicine Review (oddly, the monograph’s web page is titled “Kava Kava”), there is no indication in the peer-reviewed medical literature that milk thistle has any effect on psoriasis. And the information presented in the monograph is speculative, at best, as is Dr. Murray’s suggestions that milk thistle might inhibit proinflammatory cytokine creation, or help psoriasis by improving liver function, when there’s no evidence that a bad liver has anything to do with the cause of this disease.and Sarsaparilla (pages 788 to 790): The only clinical trial I’m aware of testing sarsaparilla against psoriasis was conducted in 1942, and it was an open study, without blinding. According to Linda M’s research, sarsaparilla is just another antiinflammatory, and Dr. Murray’s unsubstantiated speculation about “gut-derived bacterial toxins” is probably just wrong.
Dr. Murrary also mentions psoriasis in sections on other substances, as below. I’m guessing, but I believe they are not mentioned in the psoriasis section due to their less-than-stellar safety profiles.
Adrenal Cortex Extracts (pages 193 to 196): Where do corticosteroids come from? The cortex of the adrenal glands. So, why not use some “natural” steroids to combat psoriasis? Because the dosage and purity will never match what you get from a pharmaceutical company, and there is no fundamental difference between “natural” and “synthetic” steroids (at least, not as most people use those words). Dr. Murray rightly (by his scales) gives this stuff a C for both efficacy and safety. I’d give it Fs. Modern medicine has largely moved beyond ground-up glands as treatments for many diseases, for good reason.
and Selenium (pages 166 to 172): Psoriasis is lumped in the “inflammatory conditions” category under Selenium in the book, and Dr. Murray relies on old studies (apparently) to say that psoriatics have low selenium levels. There have been several studies of selenium and psoriasis.[19-25] The latest of them which measured blood levels of selenium show no deficiency at all, contrary to the earlier tests. There are no peer-reviewed studies which show that taking selenium supplements has any effect whatsoever on psoriasis, and in fact, two studies show that it has no effect at all. So, there’s no known benefit, and since Dr. Murray gives selenium a D for safety (“…must be used with caution”), the benefit-to-risk ratio is absurdly low. Don’t take selenium for psoriasis.
and Selenium (pages 166 to 172): Psoriasis is lumped in the “inflammatory conditions” category under Selenium in the book, and Dr. Murray relies on old studies (apparently) to say that psoriatics have low selenium levels. There have been several studies of selenium and psoriasis.[19-25] The latest of them which measured blood levels of selenium show no deficiency at all, contrary to the earlier tests. There are no peer-reviewed studies which show that taking selenium supplements has any effect whatsoever on psoriasis, and in fact, two studies show that it has no effect at all. So, there’s no known benefit, and since Dr. Murray gives selenium a D for safety (“…must be used with caution”), the benefit-to-risk ratio is absurdly low. Don’t take selenium for psoriasis.
Overall, Dr. Murray leaves out quite a bit of information, both about mainstream psoriasis treatments and “natural” ones. In a book which offers itself as a “complete” reference, this is inexcusable. There may be some tidbits of useful information in there, but if all you’re looking for is information about treating psoriasis naturally, save your seven bucks. There is more, and better, information available on the web. A truly complete guide to natural medicines would rival the OED in size.
(If you must have it, the Pill Book Guide to Natural Medicines is available through Amazon.com.)
More from Dr. Murray
Footnotes
Note: I reference these papers for the information contained in their abstracts only. I am aware that the full-text articles may provide valuable additional information, but I am not able to access the full text for most of these as of this writing.
1. “n-3 fatty acids in psoriasis.” Mayser et al, The British Journal of Nutrition 2002 Jan;87 Suppl 1:S77-82
2. “Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo-controlled, multicenter trial.” Mayser et al, Journal of the American Academy of Dermatology 1998 Apr;38(4):539-47
3. “Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis.” Soyland et al, The New England Journal of Medicine 1993 Jun 24;328(25):1812-6
4. “Effects of dietary fish oil lipids on allergic and inflammatory diseases.” Lee et al, Allergy Proceedings 1991 Sep-Oct;12(5):299-303
5. “Do dietary supplements of fish oils improve psoriasis?” Wilkinson, Cutis 1990 Oct;46(4):334-6
6. “A low-fat diet supplemented with dietary fish oil (Max-EPA) results in improvement of psoriasis and in formation of leukotriene B5.” Kragballe and Fogh, Acta Dermato-Venereologica 1989;69(1):23-8
7. “Ethanol-modulated cytokine production and expression in skin cells exposed to methotrexate.” Shear et al, Skin Pharmacology and Applied Skin Physiology 1999 Jan-Apr;12(1-2):64-78
8. “Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study.” Syed et al, Tropical Medicine & International Health 1996 Aug;1(4):505-9
9. “Effects of Mahonia aquifolium ointment on the expression of adhesion, proliferation, and activation markers in the skin of patients with psoriasis.” Augustin et al, Forschende Komplementarmedizin 1999 Apr;6 Suppl 2:19-21
10. “Lipoxygenase inhibition and antioxidant properties of bisbenzylisoqunoline alkaloids isolated from Mahonia aquifolium.” Bezakova et al, Die Pharmazie 1996 Oct;51(10):758-61
11. “Lipoxygenase inhibition and antioxidant properties of protoberberine and aporphine alkaloids isolated from Mahonia aquifolium.” Misik et al, Planta Medica 1995 Aug;61(4):372-3
12. “The antipsoriatic Mahonia aquifolium and its active constituents; II. Antiproliferative activity against cell growth of human keratinocytes.” Müller et al, Planta Medica 1995 Feb;61(1):74-5
13. “A double-blind evaluation of topical capsaicin in pruritic psoriasis.” Ellis et al, Journal of the American Academy of Dermatology 1993 Sep;29(3):438-42
14. “[Topical administration of capsaicin in dermatology for treatment of itching and pain.]” Reimann et al, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete 2000 Mar;51(3):164-72
15. “Review of the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction.” Hautkappe et al, The Clinical Journal of Pain 1998 Jun;14(2):97-106
16. “Effects of topically applied capsaicin on moderate and severe psoriasis vulgaris.” Bernstein et al, Journal of the American Academy of Dermatology 1986 Sep;15(3):504-7
17. “Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis.” Bjorneboe et al, The British Journal of Dermatology 1988 Jan;118(1):77-83
18. “Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid.” Teelucksingh et al, Lancet 1990 May 5;335(8697):1060-3
19. “[Selenium nutritional status and the course of psoriasis.]” Serwin et al, Polski Merkuriusz Lekarski 1999 May;6(35):263-5
20. “Fatty acids and antioxidant micronutrients in psoriatic arthritis.” Azzini et al, The Journal of Rheumatology 1995 Jan;22(1):103-8
21. “Screening of effects of selenomethionine-enriched yeast supplementation on various immunological and chemical parameters of skin and blood in psoriatic patients.” Harvima et al, Acta Dermato-Venereologica 1993 Apr;73(2):88-91
22. “Selenium plasma levels in psoriasis.” Donadini et al, Clinical and Experimental Dermatology 1992 May;17(3):214-6
23. “The effect of supplementation with selenium and vitamin E in psoriasis.” Fairris et al, Annals of Clinical Biochemistry 1989 Jan;26 ( Pt 1):83-8
24. “Selenium in whole blood and plasma is decreased in patients with moderate and severe psoriasis.” Michaëlsson et al, Acta Dermato-Venereologica 1989;69(1):29-34
25. “The pharmacokinetics of selenium in psoriasis and atopic dermatitis.” Fairris et al, Acta Dermato-Venereologica 1988;68(5):434-6
