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Herbal medicine and herbalists seem to get a lot of bad press though deaths and
incidences of adverse reactions are relatively few. Most of these incidents are
due to people self medicating or to adulteration of herbal products.
Death or adverse reactions caused by herbal medicine prescribed by a qualified
practitioner are so few as to be non existent.
This does not mean that all herbs are safe, but the proper herb taken at the
proper dosage for the right length of time in general has only positive effects.
With the new regulations it seems that herbalists are not recognized as experts in
their own field. St John’s wort may only be prescribed by medical doctors and
making herbal medicinal products unless you can afford to hire a 6 year trained
pharmacist is not an option. Throughout out all the regulations a pharmacist or
medical doctor without any training in herbal medicine is recognised as a
qualified person where a herbalist is not, herbalists have to be the only
professionals who are not recognized as authorities in their own area of
expertise. There is still debate as to whether a herbalist will be counted as
qualified for a third party prescription service. A third party prescription service is
where a prescription is made up specifically by a third party under the direction of
a herbalist for their client. Taking into account that a herbalist is qualified to make
remedies for their own clients I cannot see any reason why there is any debate
as to whether they are qualified to make up a prescription on the request of
another herbalist. It is issues like this that has compelled me to write this article.
It is estimated that around 70,000 plant species have been used for medicinal
purposes. Biomedicine still relies on plants rather than the laboratory for at least
25% of all its medicines and many of these are amongst the most effective of all
medications. In general the herbs provide for the synthesis of conventional drugs.
Such as Digoxin, which is used for heart failure, which was isolated from
common Foxglove and Quinine for Malaria. If we dismiss or try to suppress
herbal medicine what other life saving medications will not be developed?
I and most herbalists believe in integrative medicine and that both allopathic
and herbal medicine can be used together with very positive benefits. We hear a
lot about negative interactions but not a lot about positive interactions, herbs and
medications can support each other and many herbs can be used in conjunction
with medications to negate the side effects of the medication.
If a particular medication damages the liver but is in itself lifesaving then a herb
such as milk thistle known for its positive effects on the liver can be used to
protect against liver damage.
My own children are a perfect example of integrative medicine, my twin girls
were born at 31 weeks, it was an emergency caesarean section, no amount of
herbs could have saved their lives or kept them alive for the following weeks, this
was due to medical intervention and the fantastic pediatricians and nurses in the
hospital. However, one especially had weak lungs and without herbal intervention
would have definitely ended up being asthmatic. To date they have never
suffered any lung problems and are happy, healthy 4 year olds. I personally
believe that allopathic and herbal medicine has a very positive future whereby we
can combine the best of both worlds for our patients benefit.
Nicholas Culpepper
"It has an opening quality and, therefore, very effectual for removing obstructions
of the liver, gall bladder and spleen and diseases arising from them, such as
jaundice and hypochondriac.
It openeth the passages of the urine both in young and old; powerfully cleanses
imposthumes and inward ulcers in the urinary passage and by it’s drying and
temperature doth afterward heal them. For this purpose the decoction of the
roots or leaves in white wine, or the leaves used as pot herbs are very effectual.
And whoever is drawing towards a consumption or an evil disposition of the
whole body called cachexia shall find it a wonderful help. It also procures rest
and sleep to bodies distempered by the heat of ague fits or otherwise. The
distilled water can be drunk in pestilential fever and be used as a wash for sores.
This common herb hath many virtues, which is why the French and Dutch eat
them so often in the spring."
Culpepper: "It has an opening quality and, therefore, very effectual for removing
obstructions of the liver, gall bladder and spleen and diseases arising from them,
such as jaundice and hypocondriac.
This is just an example as I believe that though the language is old the theories
and medicinal applications still hold true. Scientific language, research and
methodologies have always changed and adapted with time but it does not mean
that all that came before should be rejected as nonsense. In years to come will
scientists read the above scientific reports and reject them because the language
is archaic?
I am an East West herbalist and this to me means I am privileged to be in a
position to study both the old traditions and the western sciences, I am fascinated
with both and see the integral benefit of all.
St. John’s wort is a very useful herb not only used for its anti-depressant
properties. Its other properties include alterative, antiviral, astringent, anodyne,
antibacterial, cholagogue, nervine, vulnerary, anti-inflammatory, antispasmodic,
expectorant, antiviral, sedative and vulnerary. Externally it is used for nerve pain,
burns, hemorrhoids, herpes, neuralgia, sciatica, wounds and varicose veins.
Besides depression, St. John’s wort is also used for anxiety, fatigue, jaundice,
neuralgia, rheumatism, ulcers, dysmenorrhea, flu, herpes, viral infections, HIV
and AIDS.
A herb with so much to offer is now unavailable; don’t its benefits outweigh a
concern that could be sensibly dealt with?
In the case of drugs with numerous side effects, their benefit is deemed to
outweigh any serious adverse reactions.
Are the same principles applying to all?
The proper herb taken at the right dosage for the right length of time with all
contraindications adhered to has more chance of healing than hurting a person.
Herbal medicine has at its essence the ability to heal people, and herbalists such
as myself want herbalism to move forward in its entirety, keeping the traditional
and incorporating the scientific, with a full range of herbs available to a
practitioner so as to provide the best care to their patient.
I would also like to see this available to the public who have for generations used
herbal medicine as folk medicine. This can be done safely through a publically
available safety database, patient information leaflets and trained personnel
available for advice.
The Facts: Adverse Reactions
America
According to a study done by the Journal of the American Medical
Association 1998
• incidences of serious and fatal adverse drug (ADR’s) reactions in
hospitalised patients are the fourth most common cause of death in the
USA. This is over 100,000 deaths per year.
• 2 million serious adverse drug reactions (defined as requiring
hospitalisation or causing permanent disability) annually.
• 46 people die every day from Aspirin alone in the USA.
• Avoidable medical misadventure is the sixth most common cause of death
according to the Centre for Disease Control (CDC).
A study by the Harvard Medical practice published in 1991 in the New England
Journal of Medicine estimated that 1 million people are injured by errors during
hospital treatment each year and 120,000 die as a result of these injuries.
England
• Results of the “Million Women Study” on HRT and breast cancer in the
UK were published in medical journal The Lancet in August 2003.
According to lead author Prof. Valerie Beral, director of the Cancer
Research UK Epidemiology Unit: "We estimate that over the past decade,
use of HRT by UK women aged 50-64 has resulted in an extra 20,000
breast cancers, estrogen-progestagen (combination) therapy accounting
for 15,000 of these.”(151) We were unable to find statistics on breast
cancer, stroke, uterine cancer, or heart disease caused by HRT used by
American women. Because the US population is roughly six times that of
the UK, it is possible that 120,000 cases of breast cancer have been
caused by HRT in the past decade.
Australia
• that 9,000 people die from avoidable medical misadventure and that
50,000 people are maimed by medical misadventure every year in
Australia.
Considering that until recently there has been little quality control or regulation
herbal medicine has had relatively few mishaps. With sensible control and
regulation we can look forward I hope to an era of realization where the intrinsic
worth of herbs and herbalists are recognized and incorporated into the
healthcare system. Many of the concerns relating to herbal medicine can be
easily and sensibly dealt with and indeed many already are through existing
legislations.
Herbal Medicine: Many of the cases of liver toxicity etc have been due to
adulteration of products or wrong dosaging. I have tried unsuccessfully to find
statistics for the total number of cases of Hepatoxicity due to herbal ingestion; I
can but presume they make up a certain percentage of cases of adverse
reactions in the WHO statistics, so a certain percentage of 500 cases worldwide
will be due to hepatoxicity.
Allopathic Medicine: ‘Drugs are an important cause of liver injury. More than
900 drugs, toxins, and herbs have been reported to cause liver injury, and drugs
account for 20-40% of all instances of fulminant hepatic failure. Approximately
75% of the idiosyncratic drug reactions result in liver transplantation or death.
Drug-induced hepatic injury is the most common reason cited for withdrawal of
an approved drug.
In the United States, approximately 2000 cases of acute liver failure occur
annually and drugs account for over 50% of them (39% are due to
acetaminophen, 13% are idiosyncratic reactions due to other medications).
Drugs account for 2-5% of cases of patients hospitalized with jaundice and
approximately 10% of all cases of acute hepatitis. ‘
This I hope puts hepatoxicity due to herbal medicine into perspective, it is not my
intention to underestimate any case of hepatoxicity, however, I would like to see
an overall statistic and the breakdown of each case so that we can address the
real issues. From the cases I have read some of the reasons can be broke down
into several categories which include adulteration and self medication.
The area of self medication includes wrong dosaging, taking for an excessively
long period and incompatibility due to history of liver/kidney insufficiency.
Steps to redress
Adulteration
All reputable herbal suppliers now perform tests on their products to ensure
quality and safety. These include identification and tests for contaminants. This
has now become the standard and incidents of adverse reactions due to
adulteration should not happen.
Some of these products have come from China but with western herbalists so
restricted as not to be able to make these products, European made substitutes
are unlikely. However reputable Chinese medicine suppliers do perform quality
and safety tests and guarantee quality.
Self medication
Self medication as with all forms of self-treatment can cause problems; it may
delay someone from seeking qualified advice or lead to herb- drug interactions,
adverse reactions due to wrong dosaging, hepatoxicity through being unaware of
liver/kidney function. Specific patient groups may also be at risk e.g. pregnant or
nursing mothers, children, the elderly through taking inappropriate herbs or
taking them at the wrong dose.
• Informing people on how to use the herb and detailing possible contra-
indications, warnings and potential interactions with other medicines. This
would address many of the problems i.e. interactions with other
medications and people taking herbs unsuitable for them or at the wrong
dosage.
‘Quacks’
To me this is should not be an issue, charlatans can appear in any profession
and indeed a few have hit the headlines, however if you are visiting a practitioner
or using any type of service whether it be a plumber, doctor or a herbalist it is
advisable to check that they are qualified and belong to a professional register.
This ensures that the person you are seeing is properly qualified and
professional within their practice.
The future should shine bright, an integrative system that has patient care at its
integral core using the best of what’s available for its curative benefits.
I would like to see the following aspects become a reality:
Safety
• Promote the proper and safe use of herbs by educating the public.
• Quality: properly identified, tested and quality assured raw herbs and
products.
• Data: A working co operative between the medical and herbal
establishment to identify and create a safety database including dosage,
appropriate length of time for taking the herb, negative interactions and
safety data. This information can then be publicly available and on patient
information leaflets.
• Adverse Reactions: Where adverse reactions happen, a full breakdown
of information as to the actual cause and statistics reflecting this.
• Patient Information Leaflet detailing medicinal applications, dosage,
interactions/potential interactions and contraindications.
• Trained Personnel: where herbs are supplied.
• Prescription Only: Some herbs should only be prescribed by a qualified
practitioner, but to include herbalist not just doctors which would see many
herbs fall out of use as many doctors do not herbal training. (and/or will
not prescribe them as herbs do not have sponsoring drug salesmen)
Research
• National Herbal Database: to compile information on the use of native
plants and preserve the knowledge of traditional medicine for future
generations.
• Positive Interactions: Research into the positive interactions between
herbs and drugs whereby the herb can help support the body while a
person is taking a medication. Many side effects of medications can be
negated in this way so that the person can have the best of both worlds.
• Hepatoxicity: Identify herbs with potential for Hepatoxicity because of
their constituents while researching them for this by individual constituent
and the plant as a whole.
• Traditional Use: where traditional use has been established, this may be
taken as fact until further research proves otherwise.
Integrative Medicine
• As well as having positive interactions, herbal medicine in general works
better for chronic conditions while allopathic medicine works better in
acute cases. As in the case of my daughter both systems can work
particularly well together. Quality Research and implementation could
mean better patient care for all.
• The communication between doctors and traditional practitioners should
be strengthened and facilitated with appropriate training available for both.
• A programme implemented which would allow integration into the national
healthcare system, as well as treatments being available on the medical
card ensuring access to all.
Herbalists
• Recognition of herbalists as qualified healthcare providers within their own
field of expertise.
• Herbal Medicinal products which are practitioner led rather than corporate.
.Still have to put togeher
REFERENCES
World Health Organisation. Traditional Medicine Strategy 2002- 2005 WHO
2002.
Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events.
JAMA 1995;274:35-43.
Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in
hospitalized patients: Results of the Harvard Medical Practice Study II. N Engl J
Med 1991;324:377-84.