Native Healers. Anita Ralph
herbal medicine research is being presented in the media, because often research trial data is discussed but ‘opinion’ pieces are tacked on to the end of the discussion, and presented as if they are as factual as the research itself. So even a positive herbal medicine outcome might also have the researcher comment that the public should still be wary of herbal medicine safety, for example. An alternative statement such as ‘refer to a qualified herbal practitioner’ would be more balanced reporting, and would be the equivalent to ‘seek advice from your doctor’.
Confusion about (or wilful muddling of) the distinction between herbal medicine and other complementary and alternative medicine (CAM) modalities also occurs, and can be used to ridicule herbal medicine as part of CAM. This is due to ideological beliefs that in order to further ‘rational science’, an opinion should be held that all past forms of medicine are based on flawed scientific thinking and must therefore be eradicated.
Complementary medicine is a misleading umbrella term for this cluster of unconnected theories and methods.
Osteopathy, chiropractic, acupuncture, herbal medicine, nutritional therapy, hypnotherapy? Their most obvious shared feature is their being absent from the medical curriculum.
—Professor David Peters
There are many conventional clinicians who find they have effectiveness gaps in terms of the treatment they can offer their patients in a real-life setting, and interest in complementary approaches and integrated medicine is growing among this sector.
There is inconsistency in terms of implementation of herbal medicine by governments, and dissemination of correct information to doctors about herbal medicine. Despite a Cochrane review demonstrating that St John's wort (Hypericum perforatum L.) was equivalent in efficacy to selective serotonin reuptake inhibitors (SSRI antidepressant drugs) in the UK, health claims for herbal medicines can only be based on ‘traditional use’, and so the efficacy data for St John's wort cannot be used as advice for doctors. It could be argued that this set up keeps herbal medicine in a ‘traditional use’ straight-jacket.24
A large amount of pharmacological evidence for herbal medicine and its compounds exists, as does some clinical evidence. Although plants contain multiple compounds, and traditional use often mixes multiple plants, pharmacological evidence will often support traditional use. An example of this would be the growing body of research confirming improved bioavailability of phytochemicals resulting from the use of complex plant mixtures (a form of synergy in whole plant medicines).25
Research data on herbal medicines can be found in journals such as:
The Journal of Herbal Medicine (Elsevier)
Phytotherapy Research
Planta Medica
Journal of Ethnopharmacology
Fitoterapia
Phytomedicine
Online searches via Pubmed/Medline and Google Scholar may also prove fruitful.
Herbal safety
Some examination of what we mean by safety, what we mean by adverse events and the case to answer is needed. Clarification of what is meant by placebo, and in terms of herbal safety what is meant by nocebo, is also required.
The common refrain ‘just because it is natural doesn't mean it is safe’ is often applied to herbal medicine. To some extent this is true. Plant identification by those wishing to harvest a herbal medicine from the wild has, and can, result in potentially dangerous misidentification. Unscrupulous companies marketing herbal products have and can sell defective, adulterated and occasionally poisonous ‘herbal’ products. Issues of quality have been and continue to be a very real problem, which means it can be difficult for those wishing to self-medicate for minor ailments with herbal medicine to do so effectively. Each European country has its own rules about quality, but companies based outside of the EU may have little or no regulation or pharmaco-vigilance.
In the UK, herbal products provided to practitioners of Western herbal medicine have the highest standard of good management practice ensuring the quality of the end product. A licensing scheme for over-the-counter products exists for herbal products in the UK not provided via a practitioner and these products clearly state they are licensed and contain a public information leaflet.
Once again reporting of herbal safety is not conducted using the same criteria applied to conventional medicine. Many adverse herbal medicine events occur as the result of excessive ingestion of a plant.
Definition—Adverse reaction: A response to a drug that is noxious and unintended and which occurs at normal doses for human use.
Even in the instance of such a plant being medicinal, most reported adverse reactions have occurred when significant overdoses were taken.
That does not mean that all herbs are safe, and herbalists are, and should be, hyper-vigilant. Medical herbalists have a yellow-card reporting scheme for herbal medicines, as exists for conventional medicines. We should always work from the assumption that any herbal remedy consumed is done so respectfully, and for a targeted purpose—to relieve suffering, to promote healing and wellbeing, and with an aim to restore resilience and function.
Particular care should be taken when people are taking conventional medicine, and/or mixing herbal medicines or taking herbs with vitamins and mineral supplements.
Medical herbalists are trained in pharmacology and are the experts in using plant medicines in a modern context of conventional drugs and over-the-counter remedies.
It has become increasingly clear that the UK government and the MHRA (Medicines and Healthcare Regulatory Agency) do not have any great concerns about safety with regard to the practice of herbal medicine by registered practitioners. Statutory regulation for herbal practitioners in the UK has been rejected several times, and lack of public risk is repeatedly given as a key reason for this.
Things to consider with regard to herbal safety:
a)Be aware of rare but known adverse reactions to some herbs (e.g., Actaea racemosa L. has been known to cause self-limiting but unwanted headaches in rare cases.)
b)Remain alert to issues of safety and observe any signs for potential harm to liver, kidney, heart or other body systems.
c)There are rare but occasional risks of phototoxicity or allergy with any substance.
d)Be mindful of vulnerable sectors of the population.
e)Be mindful of the small number of conventional medicines which are genuinely vulnerable to herb/drug interactions (this includes drugs that operate within a narrow therapeutic dose such as anticoagulants or immune-suppressant drugs).25
Actaea racemosa (L.) was previously, and more commonly, known as Cimicifuga racemosa, or black cohosh. Concerns have been raised about this herb in connection with serious liver damage. Research into this issue has not, to date, been able to prove conclusively that the small number of cases of liver damage recorded are definitely attributable to Aceta racemosa (L.) and were in fact products made with a non-medicinal plant wrongly identified as Actea racemosa.
Another implication of herbal safety has arisen from plants that contain unsaturated pyrrolizidine alkaloids (PA's) such as comfrey (Symphytum officinale L.), coltsfoot (Tussilago farfara L.) and borage (Borago officinalis L.). Use of these herbs has been restricted or banned in some countries, despite concern that the animal and human case-study data used to inform and legislate may have been flawed. There are numerous PA's found in plants, they undergo complex metabolic change via liver pathways, and range from dangerous unsaturated PA's to the least toxic forms. Small amounts of the most toxic can be found in coltsfoot, large amounts of the least toxic in comfrey, while borage, (eaten widely as a vegetable in Europe) appears relatively benign all round. A person's liver health, drug and alcohol use, and nutritional deficiencies (such as antioxidants)