Healthy living
Complementary therapies
Tailor-made herbal remedies under fire
Does mixing your herbal medicines put you at risk?
There was a time - a while ago, admittedly - when the only medicines you could lay your hands on were made directly from herbs. Then there was a time when pretty much the only medicine you could take came in the form of drugs prescribed by your doctor. We haven't exactly come full circle, but these days we have choice, and not just either/or but both, thanks to the increasing availability of herbal remedies in our high streets and over the internet.
But is combining herbal and conventional medicine a good thing? It’s a matter of hotly-debated opinion, particularly in the case of individualised herbal medicine, where practitioners prescribe a combination of herbs based on the needs of individual patients.
The case against
A recent study carried out by scientists at the Peninsula Medical School, Universities of Exeter and Plymouth made headlines when it claimed that there is little evidence regarding the effectiveness of individualised herbal medicine and no convincing evidence to support its use.
The study, carried out by Professor Edzard Ernst, Professor of Complementary Medicine at the Peninsula Medical School, and colleagues, and published in the BMJ Postgraduate Medical Journal, looked for randomised, controlled, clinical trials with which to judge how effective this kind of herbal medicine is. 'The embarrassing truth is that there are only three rigorous trials in this area,' says Professor Ernst. And he goes on to state in an editorial in the journal, 'Today there is not a shred of evidence to suggest that traditional herbalists do more good than harm.'
The three trials looked at the treatment of knee osteoarthritis and irritable bowel syndrome and the relief of side effects caused by drug treatment for cancer. In the knee and cancer treatment studies there were no statistical differences between the tailored herbal medicines and the placebo. In the irritable bowel study the herbal medicines seemed to work better than the placebo, but not as well as standard treatments.
The report also states that because an individual approach to patients involves prescribing a number of herbal remedies, there’s a higher chance of these herbs reacting with each other, and with any prescription medicines the patient may be taking, with potentially serious consequences.
The case for
Herbal medicines have been with us for a long time, since humans started trying to find ways to cure their ailments. These days they’re big business. As the study points out, in 2003, Europeans spent £2.53 billion on over-the-counter herbal medicine.
‘Herbal medicines have been tested on humans for thousands of years,’ says Jane Gray, Vice President of the National Institute of Medical Herbalists (NIMH) the UK’s leading professional body representing herbal medical practitioners. ’You could say that herbal medicine has had the longest running human trial.’
‘It’s true that there aren’t many randomised, controlled trials,’ says Jane Gray. ‘But there are certain difficulties in running these trials. Herbal medicines have a very specific colour, taste and smell, it’s difficult to create a placebo that’s identical without using the same herbs. Because we can’t do randomised clinical trials we do patient outcomes and clinical audits.’
The members of NIMH take issue with the science behind the report, pointing out that only one of the three studies reviewed was on western herbal medicine as their members practice it. They have also stated that they feel it is poor science to draw from that lone pilot study, on only 14 patients, any conclusion about the benefits of western herbal medicine.
‘We do understand Professor Ernst’s view,’ says Jane Gray. ‘He wants to have stringent, randomised controlled trials, but this isn’t the only research that’s relevant. There are other places you can turn to for documentation.’ One of these is the government-administered Yellow Card reporting scheme, run by the Medicines Healthcare products Regulatory Agency. Healthcare professionals, medical herbalists and members of the public use it, to make reports about any adverse reactions they or their patients have experienced from a medicine or herbal remedy. The reports are available for anyone to read.
‘Our evidence is based on the good health of our patients,’ says Alix Rodwell, also of the National Institute of Medical Herbalists. ‘We always ask what other medication our patients are taking and take it into consideration, and we list all the ingredients, in English, on the back of the medicine bottle and ask our patients to tell their doctor what they’re taking. Members of the National Institute of Medical Herbalists have to have done a three year BSC honours degree in herbal medicine, and have to continue their training once they are members and have to incorporate the latest research into their practice. We work with GPs and consultants to achieve the best possible health for our patients.’
The next question has to be, what do GPs make of this situation?
‘GPs recognise that a lot of people take herbal preparations, so we’re very clued up about it,’ says Dr Jim Kennedy, Chair of the Prescribing Committee of the Royal College of General Practitioners. ‘And a lot of the drugs that we use come from botanical roots. However, the active ingredients in herbal medicines are not pure, you may have multiple ingredients and the concentrations can vary widely. Herbal remedies have an important role in finding and developing new treatments, but there’s more assurance in a pill. I know what I’m getting in the pill. I’m not sure what I’m getting in the plant.’
‘The National Institute of Medical Herbalists are trying to be responsible in the way that they do things. They recognise that there’s a paucity in research. There’s a funding structure to develop trials around drugs, but who has a commercial interest in funding trials on herbal preparations? Very few companies do. Consequently there’s little funding for this scientific research.’
Don’t do-it-yourself
One point that both sides do agree on is that self-medication with herbs is not advisable. There’s good reason to take advice before dosing yourself up with herbal remedies you’ve bought over the internet or on the high street. Some herbal remedies are known to react with conventional drugs. St John’s Wort, for example, (used for mild to moderate depression) can affect the levels of Warfarin in your blood (a drug used to prevent blood clots).
‘We always strongly advocate that you don’t take over-the-counter remedies,’ says Alix Rodwell. ‘But if you do decide to take something you’ve bought over the counter, you must speak to your doctor.’
New rules
European and UK regulations are in the process of changing, so that in the future no-one will be able to practise as a herbalist unless they are registered with the central body. The specific details are still under discussion.
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Information on this site is for interest only and is not a substitute for professional medical advice. You should consult your own doctor about any specific health concerns.
