Herbs are drugs

"... the herbal product industry is just another drug industry, one selling products that are poorly regulated and likely don't work for their claimed indications...The deception inherent to the herbal product industry, in my opinion, is the notion that herbs are something other than drugs. This is closely tied to the naturalistic fallacy: the idea that a substance that is "natural" (a poorly defined concept) is somehow magically safe and effective...As with many things, the marketing of herbal products is largely based on ideology and a compelling narrative rather than actual science and evidence. For the most part consumers are left to their own devices to sort out which products are likely to be useful...keep in mind that if an herbal product contains a useful active ingredient, it would likely be identified, purified, and properly studied. The best result is likely to come from taking a precisely measured amount of a specific active ingredient with known pharmacokinetics and pharmacodynamics as well as drug-drug interactions. Herbs are not only drugs, they are a mixture of various drugs of unknown dose, activity, and interactions, often with evidence that they do not work. It takes effective marketing to convince the public this is somehow better than taking highly purified and studied pharmaceuticals." Steven Novella, MD, The Committee For Skeptical Inquiry (March/April 2013)

Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews

CONCLUSIONS: “Collectively these data suggest that there are reasons for concerns with regards to the quality of HMPs. Adulteration and contamination of HMPs can cause serious adverse effects. More stringent quality control and its enforcement seem to be necessary to avoid health risks.” Posadzki P, Watson L, Ernst E. Eur J Clin Pharmacol. (29th July 2012)

Blog post on the above overview: Contamination and adulteration of herbal remedies

"There are, of course, several reasons why supposedly "natural" herbal treatments can be unsafe. Plants extracts can be toxic, they might interact with prescribed drugs or they can be contaminated or adulterated. The latter two terms describe similar but not identical phenomena: contamination means the accidental addition of substances which should not be present in an herbal remedy; and adulteration signifies the deliberate addition of ingredients. If the substances in question are not pharmacologically inert, their presence in herbal remedies can cause adverse effects. Both contamination and adulteration break laws and regulations; both are therefore illegal. Sadly, this does not mean that such things do not happen. We have recently published an overview of the existing knowledge in this area. For this purpose, we summarised the evidence from 26 previously published reviews. Our findings were interesting but far from reassuring: the most commonly found contaminants were dust, pollen, insects, rodents, parasites, microbes, fungi, mould, pesticides, and heavy metals. The adulterants invariably were prescription drugs such as steroids, anti-diabetic medications etc. These substances were implicated in a wide range of serious adverse effects in the unfortunate patients who took the remedies in question: agranulocytosis, meningitis, multi-organ failure, stroke, arsenic poisoning, mercury poisoning, lead poisoning, caner, encephalopathy, hepato-renal syndrome, kidney damage, rhabdomyolosis, metabolic acidosis, renal failure, liver failure, cerebral oedema, coma, and intra-cerebral bleeding. Several patients did not survive." Edzard Ernst (12th January 2013)

Information Resource: About Herbs, Botanicals and Other Products

Evidence-based information on herbs, botanicals, vitamins, and other supplements. Provides objective information for oncologists and healthcare professionals, including a clinical summary for each agent and details about constituents, adverse effects, interactions, and potential benefits or problems. A consumer version of each monograph is also available to help deal with the often confusing claims made for over-the-counter products and regimens. (Memorial Sloan-Kettering Cancer Center)

Herbal medicines

What you need to know as a consumer. UK Medicines and Healthcare products Regulatory Agency (MHRA)  If you have experienced side effects using a herbal remedy, report them to your GP or online here.  Suspected side effects to any medication, including vaccines, can also be reported. [UK ONLY]

Buying and using herbal medicines

Advice on buying and using herbal medicines. Includes related information on buying medicines over the internet, marketing authorisations, patient reporting of adverse drug reactions, 'Herbal Safety News', and the side effects of medicines. UK Medicines and Healthcare products Regulatory Agency (MHRA)

How effective is individualised herbalism?

“If a patient consults an herbalist in the UK or anywhere else he/she will, in all likelihood, not be treated according to the principles of ‘rational herbal medicine’, i.e. with one evidence-based herbal medicine that has been demonstrated to be efficacious for her condition. Instead, treatment will be individualised and concocted according to diagnostic criteria unknown or obsolete in conventional medicine. Thus 10 patients with the identical mainstream diagnosis might receive 10 different mixtures of herbs, none of which is evidence-based. This is true for traditional herbalisms of all kinds, e.g. Chinese, Indian or European. Some claim that this type of individualised approach cannot be tested in clinical trials, but this notion can easily be shown to be wrong: several, albeit not many such studies testing individualised herbalism have been published. To the dismay of traditional herbalists, their results fail to confirm that such treatments are effective for any condition…As this type of therapy employs a multitude of ingredients, the danger of adverse-effects and herb-drug interactions might be considerable. It seems to follow, that the risks of individualised herbalism do not outweigh its benefits…Yet, I fear, that neither the public nor the regulators, who are about to regulate this sector in the UK, are aware how poor the evidence for the most commonly used type of herbalism truly is.” Professor Edzard Ernst, emeritus Professor of Complementary Medicine, Pulse (27th June 2012)

Herb-drug interactions: an overview of systematic reviews

“The majority of the herbal medicinal products evaluated in systematic reviews were not associated with drug interactions with serious consequences. However, the poor quality and the scarcity of the primary data prevent firm conclusions.” Posadzki P, Watson L, Ernst E. British Journal of Clinical Pharmacology (June 2012)

The Wild World of American 'Supplements'

“The latest supplement toxic alert thankfully involves only two young soldiers who died suddenly, both reported to have the unregulated amphetamine-like dimethylamylamine, DMAA, aka ‘Jack3d’ and ‘OxyelitePro’, as the suspected death-dealing toxicant. Who knows how many other unexplained deaths and near-deaths can be attributed to the vast experiment foisted upon an unwary American populace by such drugs -- I mean, ‘supplements’? Thanks to 1994's Hatch Act, the Dietary Supplement Health and Education Act (DSHEA), pushed through Congress and released upon a then-unprotesting public by Utah's Sen. Orrin Hatch (R-UT), substances which may be benign, toxic, and everything in between, as long as they are sold as ‘dietary nutritional supplements’, get a virtual free pass. The supplement manufacturer can make "structure-function" claims, such as ‘supports sexual health’, but not health claims. Such assertions must clarify that the substance is not FDA approved ‘to diagnose, treat, cure or prevent any disease’. Part of the law mandates that ingredients brought to market after 1994, so-called ‘novel’ ingredients -- and only those -- be shown to have passed safety tests. Older ingredients got ‘grandfathered’ in without the need to be proven either safe or effective. How is that working out? There have been approximately 51,000 new ingredients brought to market since DSHEA passed, of which about 0.3% -- that's not a misprint, 170 out of 51,000 -- have documented safety tests. Who cares? ‘Why worry?’, perhaps under the delusion that some substance termed "natural" must be safe, seems to be the governing mantra of the American consumer on this subject, since about 100 million of us spend, at last tally, over $28 billion per year on these products -- vitamins, minerals, potions, herbals, biologicals, who-knows-what. If a shopper has a question about the efficacy or danger of a supplement, they may simply ask the health-food store employee. Obviously, trusting a sales clerk to be expert is pure foolishness.” George Lundberg, MD, Editor-at-Large, MedPage Today, President of the Lundberg Institute,consulting professor of pathology and health research policy at Stanford University School of Medicine anda member of the Institute of Medicine (5th March 2012)

Medicines Derived from Herbs

“Herbal medicines are currently quite popular; consumers are spending billions on them each year. Enthusiasts praise them as natural and safe, while skeptics often see them as little more than glorified placebos. The general public is frequently confused by such controversies, by a plethora of misinformation, and by the bewildering categories of medicines derived from herbs. Here I will try to clear up some of this confusion by explaining what the different categories are.” Includes a critical look at Bach Flower Remedies, anthroposophical medicines (developed by Rudolf Steiner), and the way the public frequently confuses homeopathic remedies with herbal medicine. Edzard Ernst, Skeptical Enquiry (January /February 2012)

Report on the 'Safety of herbal medicinal products'

Useful safety information for anyone using herbal medicines and anyone operating in the herbal medicines sector, including manufacturers, herbal practitioners, suppliers and retailers. UK Medicines and Healthcare products Regulatory Agency (MHRA) [pdf]

“Herbal” drugs still get free pass with vast potential for harm

"While drugs in the U.S. must undergo extensive testing and monitoring to ensure their safety and efficacy, supplements come under much weaker regulation. In a perspective article in The New England Journal of Medicine, Dr. Pieter A. Cohen criticizes the current deficiencies in the regulation of the supplement industry. He argues that a new guidance proposal by the FDA makes important steps toward enhancing supplement safety — but it still doesn’t go far enough."  Health Facts and Fears (26th January 2012)

Screen dead for herbal toxicity: pathologist

“University of Adelaide professor of pathology Roger Byard, who was speaking at a conference in Perth said doctors and police officers investigating suspicious deaths should routinely check for herbal toxicity as well as the presence of drugs. He presented research at the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists annual meeting and called for a new research area to be set up in forensic herbal toxicology. Professor Byard said herbal medicines had mostly come from complex Chinese and Indian medical traditions. While many were effective there was now a problem with traditional village-based activities expanding into a global market, affecting the quality, composition and purity of supplies. He was aware of a recent case of a young man who died after injecting himself with what he thought was the drug ecstasy. But the dealer had substituted it with the Chinese herbal medicine, chan su, which contains venom from the skin of toads.” Australian news report (5th December 2011)

Economically-Motivated Herb Adulteration

“The use of cheaper materials in drug and supplement products came to light with melamine used to artificially boost apparent protein content in pet food and infant formula products in China. In 2009, the Council for Responsible Nutrition released a statement on the problem of economically-motivated adulteration in the supplement industry. While the new Good Manufacturing Practice guidelines for the industry were intended to address this issue, the current USDA analytical paper tells us that more stringent enforcement of the rules is necessary.” David J Kroll, Science Based Medicine (2nd September 2011)

Buyer beware? Does the information provided with herbal products available over the counter enable safe use?

Conclusions: "Most of the herbal medicine products studied did not provide key safety information which consumers need for their safe use. The new European Union legislation should ensure that St John's wort and echinacea products will include the previously missing information in due course. The legislation does not apply to existing stock. Depending on therapeutic claims made by manufacturers, garlic, ginkgo and Asian ginseng products may not be covered by the legislation and can continue to be bought without the safety information. Also, consumers will still be able to buy products over the internet from locations outside European Union jurisdiction. Potential purchasers need to know, in both the short term and the long term, how to purchase herbal products which provide the information they need for the safe use of these products." David K Raynor, Rebecca Dickinson, Peter Knapp, Andrew F Long and Donald Nicolson, BMC Medicine (9th August 2011)

Warning on herbal meds before ops

Patients who are admitted to hospital for planned surgery without informing doctors about what herbal medicines they are taking may be placing themselves in danger of potentially serious complications, a team of Dublin anaesthetists has warned. They say: “Lack of scientific research on herbs, combined with the lack of regulation of herbal preparations can give consumers a false sense of security about the safety of herbal products”. Irish Health news report (26th July 2011)

Herbalists: If Ancient Wisdom Exists, So Does Ancient Stupidity

“If a serious side effect occurred in one in a thousand recipients of an herb, or even one in a hundred, no individual herbalist would be likely to detect it. If a patient died, they would be more likely to attribute the cause to other factors than to herbs that they believed were safe. Even with prescription drugs, widespread use regularly uncovers problems that were not detected with pre-marketing studies…When you take an herbal remedy, you are taking
1. An active ingredient that usually has not been adequately tested,
2. Other components that have not even been identified, much less tested,
3. An uncertain amount, and
4. Possible contaminants.
The term “street drugs” comes to mind: you don’t really know what you’re getting.”
Harriet Hall MD, Science Based Medicine (30th March 2011)

The difference between herbal medicines, and herbalists

“There is a big difference between using a scientifically proven herbal medicine for a specific condition and consulting a traditional herbalist, and thus receiving herbal therapy via this route. No good evidence exists to show that the latter approach does more good than harm. These individualized prescriptions are based on obsolete notions straight from the dark ages. In contrast, some herbal medicines are supported by sound evidence…The message for GPs is simple: the next time you are tempted to send a patient to a traditional herbalist, think twice.” Professor Edzard Ernst, Pulse (28th February 2011) [Free registration]

(UK) Government lends credibility to quacks and charlatans

“The long-awaited government decision concerning statutory regulation of herbalists, traditional Chinese medicine (TCM) and acupuncture came out today. It is not good news. They have opted for statutory regulation by the Health Professions Council (HPC)…The vast majority of herbalists, traditional Chinese medicine (TCM) and acupuncture has no good evidence that it works. In the case of some herbal medicines and acupuncture, there is good evidence that they don’t work. Yet the HPC has, as one of its criteria, that aspiring to be regulated by them requires "practise based on evidence of efficacy". The Department of Health seems to have quietly forgotten about this criterion. It cannot possibly be met. The HPC has already expressed its willingness to go along with this two-faced approach. Another mistake made by the Department of Health regards the value of ‘training’…Spending three years training people to learn things that are not true, safeguards nobody. On the contrary, it endangers the public. Training in nonsense is obviously a nonsense.” Professor David Colquhoun, DC Science blog (16th February 2011)

New (UK) herbal medicine regulations are useless

2:44 min BBC Business News segment: A pharmacist earnestly appears to make totally unfounded claims for echinacea and goldenseal, as well as unsubstantiated claims for treatment for menopausal hot flushes. An MHRA man evades the essential point - fraudulent labeling. Professor David Colquhoun points out that it is a disgrace that there is still no indication of whether treatments work.  The UK government and MHRA apparently bend over backwards to support producers at the expense of consumers who get saddled with useless products.

Echinacea for colds and ‘flu

“In the current issue of the Annals of Internal Medicine there is a new study of Echinacea for the treatment of cold symptoms: Echinacea for Treating the Common Cold, A Randomized Trial. I won’t hold out the punchline – the study was completely negative. But let’s put the results of this study into the context of the history of echinacea and the clinical evidence…..The prior plausibility for echinacea as a cold remedy is very low, but not zero. As an herbal product it can feasibly have biological activity. The claim that it “boosts the immune system” is not credible, as such a phenomenon is not generally accepted. Basic science research essentially finds that the immune system is activated by echinacea, but this has not been distinguished from a non-specific immune response to a foreign substance. In other words, stimulating the immune system non-specifically (I can do this by punching you in the arm) and “boosting” the immune system so that it functions more effectively against an infection, are not the same thing. Leaping to the latter conclusion is not justified by the evidence.” Steven Novella, MD, Science Based Medicine (22nd December 2010)

Herbal Medicine: An Overview of the Literature From Three Decades

Conclusion: These findings are consistent with the notion that the quantity and quality of RCTs of herbal medicine have been improving during the last three decades. We suggest that the adaption of the herbal-medicine-specific Consolidated Standard of Reporting Trials guidelines might further improve the situation in future. Shao-Kang Hung and Edzard Ernst, Journal of Dietary Supplements (September 2010)

Traditional herbalism: no good evidence that it works

“What follows is simple and in stark contrast to what many people seem to assume: today there is no good scientific evidence to demonstrate that traditional herbalists do more good than harm.” Professor Edzard Ernst, Pulse (18th August 2010) [Free registration]

Cancer patients warned against DIY remedies

“Cancer patients risk shortening their lives by taking herbal remedies and supplements which stop their conventional treatment working properly, Scottish doctors have warned. Some common complementary therapies, such as St John's Wort or special ‘anti-cancer diets’, can increase or decrease the amount of chemotherapy drugs circulating in the body.” The Scotsman (25th July 2010)

Herbal Medicines a Mystery to Most Doctors

"Physicians don't know much more about complementary and alternative medicine than their patients do, according to a new survey. Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%). And almost half of respondents rated their own knowledge about herbal medicines as "quite" or "very" poor (36.2% and 10.4%, respectively). Even more worrying, journal editor Ike Iheanacho, MBBS, said in a podcast released in conjunction with the survey, was that medical professionals exhibited a lack of interest in even asking whether patients were taking herbal compounds.  More than half of respondents said they never or only occasionally (8.6% and 46.6%, respectively) ask when reviewing patients' medications whether they are taking herbal medicines.” MedPage Today (7th April 2010)

Ginkgo biloba – No Effect

“….published in JAMA this week are the results of the largest and longest trial to date of Gingko biloba for the improvement of cognitive function and to treat, prevent, or reduce the effects of Alzheimers disease or other dementia. The results of the study are completely negative…These results call into question the practice in many countries of allowing pharmacological agents like G biloba to be marketed as supplements with health claims prior to being adequately studied. The European and US markets for G biloba are in the hundreds of millions of dollars per year. It will be interesting to see what happens following this study…The study did find that G biloba was generally safe. However, it should be noted that G biloba, although sold in the US as a supplement, should be considered a drug. It does have an anti-platelet blood-thinning effect and should not be taken prior to surgery. However, because many people think of herbs as supplements and not drugs, patients rarely disclose their supplements to their doctors, and doctors fail to take a supplement history. Safety is therefore still an issue.” Steven Novella, MD, Science Based Medicine (30th December 2009)

Totally Hypothetical Remedy? — MHRA introduce certification mark for herbal remedies

"According to the Medicines and Healthcare Regulatory Agency (MHRA), this indicates that the herbal medicine has been registered with the MHRA under the Traditional Herbal Registration (THR) scheme and meets the required standards relating to its quality, safety, evidence of traditional use and other criteria as set out under the Traditional Herbal Medicinal Products Directive (THMPD) 2004/24/EC. There have been 92 applications since the scheme began in March 06. The most important line is this one:

Under this scheme, the permitted indications for the medicine are based on traditional usage and not on evidence of effectiveness of the product.

So, as I wrote before with homeopathy, as long as the seller can demonstrate safety of the product and a history of use for the particular therapeutic indication, then it can receive the THR stamp and be sold legitimately, despite there being no investigation into whether it works or not…On a positive note, any product with this mark on it will single it out clearly and obviously to me as snakeoil - if it were a *real* medicine that, you know, actually had some effect, then it would be marketed as such and would have some evidence to back it up. So, perhaps we should look at this stamp as a victory for evidence-based medicine, as it singles out products without any provable efficacy for all to see."  Thinking Is Dangerous blogspot (23rd October 2009)

Warning Over Unlicensed 'Herbal Valium'

“The Medicines and Healthcare products Regulatory Agency (MHRA) is warning people of the dangers of taking unlicensed herbal medicines containing aconite. Aconite has recently been portrayed in the media as 'herbal valium', however, it is actually an extremely poisonous plant that is toxic to the heart. It is also known as monkshood and herbal products containing this ingredient could be fatal or cause serious illness if consumed…MHRA Head of Herbal Policy, Richard Woodfield, said it was vital people did not confuse herbal medicines and omeopathic ones. "Registered homeopathic products that contain aconite are considered acceptably safe as the active ingredient, aconite, is sufficiently diluted," he said. "Herbal medicines are made from plants and so can have a very significant effect on the body. In certain cases, such as with aconite, the medicine can be extremely potent. "This is a classic case where 'natural' does not mean 'safe'."” Medical News Today (5th October 2009)

Commercial deception: undeclared drugs in herbs and other dietary supplements

"…adulterating commercial herbal products with prescription drugs is so common that the US FDA is keeping a running tally of actions against companies selling supplements containing "undeclared drugs": the polite regulatory term for deceptive doping of a useless product with a real drug…Most concerning is when these adulterants might interact with other medications a patient is taking …to dope supplement products with effective drugs is to admit that one is selling garbage: a deceptive practice to prey upon those who choose to seek out "alternative" medical approaches and keep them coming back….This practice also makes one wonder how many anecdotal cases of "success" with herbal products could be attributed to adulteration with prescription drugs. For this reason, I recommend that grant reviewers and journal editors insist that any dietary supplement used in a clinical trial be subjected to extensive chemical analysis as a condition of funding or publication, respectively, including screening for pharmaceutical compounds capable of exerting the therapeutic effect under investigation." Article by David J Kroll, Science Based Medicine (14th April 2009)

FDA Warns Consumers to Stop Using Hydroxycut Products

The FDA has ordered a recall of all Hydroxycut products, because of liver toxicity. Hydroxycut is a widely advertised product that is marketed as a rapid weight loss dietary product. US Food and Drug Adminstration News (1st May 2009)

Informing the Public Responsibly About Herbal Medicine

"The current popularity requires reliable information in this sector to minimize harm and maximize benefit. Currently there are only very few such sources of information aimed at the lay public. Instead, we have a plethora of seriously misleading texts. In the interest of public health, we need reliable, unbiased, and easily accessible information." E. Ernst, Journal of Dietary Supplements (March 2009)

Complementary and Alternative Medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia

"This January 2009 report from the Arthritis Research Campaign (UK) must be interpreted carefully. In Part 1, it lists and evaluates 40 products that have been studied in randomized, controlled trials (RCT). The ratings they assign range from 1-5. I take exception to the rating system because a rating of "1" really means there is *zero* evidence of effectiveness, and a rating of "3" (which may *look* okay) really means there is little evidence of effectiveness. Of the 40 products, 36 are rated "3" or below. Only four have good evidence for effectiveness in RCTs. It is not enough to cite an RCT, such a study must be large-enough to be believable — minimally, 100 subjects, preferably 200 (a "Phase 3" clinical trial would have 2,000 subjects). Moreover the study should not have too many subjects who drop out. The ARC relies on studies that fail one, or both, of those criteria and are, thus, dubious (some are marked as such). In Part 2, the ARC study lists another 36 products that are offered to treat arthritis that have not been subjected to any reliable study. Properly considered, the ARC study, in aggregate, cautions one that there are 72 products offered for relief of arthritis with little, or no, evidence of effectiveness. Seen that way, it is a useful warning. Of the total number (76) of products examined in Parts 1 and 2, 70% are herbal." Review summary by Joe Magrath, Ph.D. (27th February 2009) [pdf]

Limitations of 'Evidence-Based Indications' for Herbs

"Most clinical trials that support the efficacy of herbals are financed by their manufacturers. Critical reviews of the quality of those clinical trials reveal serious limitations, including small sample size, short study duration, and lack of allocation concealment or double-blinding. In addition, most of these studies fail to disclose the source of funding and the identity of those who analyzed the data. Despite these shortcomings, many reviews conclude that the clinical trial data are inconclusive but "promising." Evaluation of therapeutic agents also requires an assessment of risks. Data on the toxicity of herbals are very limited because adverse events are evaluated only by patient self-reports and because clinical trials lack monitoring of hepatic or renal function." (The reliability of the Natural Standard as a source of evidence-based indications is also questioned.) Donald M. Marcus, MD , Baylor College of Medicine, Houston, Texas, and Arthur P. Grollman, MD, State University of New York at Stony Brook (Mayo Clinic Proceedings, November 2007)

The trouble with herbals

"…..there are structural problems in the way that herbalists work: they have failed to collectivise, so they do not work together on research, but rather as independent commercial traders. They tend not to move into university settings, where the culture of critical self-appraisal might infect them. And where alternative therapists do move into universities, they wall themselves off from the most valuable influences. They don't rub shoulders with colleagues from other disciplines, who could share ideas with them. The alternative medicine courses I have approached have flatly refused to tell me the most basic things, like what they teach and how. It's because of this culture, not funding, that the "research" on herbal remedies is inadequate. Huge numbers of "trials" are produced, at great expense, but they are inept, they are not fair tests, they have inadequate blinding and randomisation, positive results alone are cherry-picked, and worse." Ben Goldacre, MD, Bad Science (October 2007)

Herbal medicines fail test

"A paper published in the Postgraduate Medical Journal, October 2007, has been reported widely. In the same issue there was a commentary by Edzard Ernst. They show the astonishingly poor evidence that herbal treatments work, despite the fact that they have been around for thousands of years." Article by Professor David Colquhoun, Dept. of Pharmacology, University College London (DC's Improbable Science, October 2007) [See the study linked to below]

A systematic review of randomised clinical trials of individualised herbal medicine in any indication

Conclusion: Individualised herbal medicine, as practised in European medical herbalism, Chinese herbal medicine and Ayurvedic herbal medicine, has a very sparse evidence base and there is no convincing evidence that it is effective in any indication. Because of the high potential for adverse events and negative herb–herb and herb–drug interactions, this lack of evidence for effectiveness means that its use cannot be recommended. R Guo , P H Canter , E Ernst, Postgraduate Medical Journal 2007;83:633-637 (October 2007)

BBC2 series on Alternative Medicine (herbalism)

A critical review of part three of the BBC2 series 'Alternative Medicine: The Evidence' which looked at herbalism. By David Colquhoun, FRS, A. J. Clark Professor of Pharmacology at University College London, (8th February 2006) [Includes the current evidence on Sutherlandia and St John's Wort]

Euro-court backs vitamin restrictions

"British herbal medicine retailers suffered a fresh blow yesterday when a European court upheld new rules restricting what they can sell." The European Court of Justice has upheld new rules on the sale of vitamin and mineral supplements. The new Food Supplements Directive, which comes into force on 1st August 2005, will ban around 200 supplements from sale. StaffNurse.com (18th July 2005)

Herbal remedies are not risk free

An article looking at the risks to children posed by herbal medicine and other CAM therapies. Edzard Ernst, The Guardian (14th June 2005)

Prescribing herbal medications appropriately

"Safety issues related to herbal medicine are complex: possible toxicity of herbal constituents, presence of contaminants or adulterants, and potential interactions between herbs and prescription drugs." A critical look at the efficacy, safety, quality and cost issues involved in the prescribing of herbal medicines. Edzard Ernst, Md,PhD, FRCP, FRCPEd, The Journal of Family Practice (December 2004)

Shedding the light

"A third of us have tried herbal medicine, yet few have more than a vague idea about what it actually is." Edzard Ernst, The Guardian (17th August 2004)

Medicine Man

"Traditionally a herbal remedy was taken on its own. It was certainly not combined with the drugs we use today. Therefore, herb-drug interactions are an important consideration. The lesson we should learn form all this is one of caution and common sense. Natural is not necessarily safe and a long history of use is a far cry from providing guarantees." Edzard Ernst, The Guardian (13th July 2004)

Are people who use 'natural drugs' aware of their potentially harmful side effects and reporting to family physician?

"In conclusion, although the use of natural drugs is extensive, patients' knowledge of their potential adverse effects is poor. A public educational campaign, with inclusion of the need to report such usage to the family physician, should be implemented, and questions on the use of complementary medicine/natural drugs should be incorporated as an integral part of the history taking by primary care physicians." Giveon SM, Liberman N, Klang S, Kahan E., Patient Educ Couns. 2004 Apr;53(1):5-11

Internet Marketing of Herbal Products

Consumers may be misled by vendors' claims that herbal products can treat, prevent, diagnose, or cure specific diseases, despite regulations prohibiting such statements. The Journal of the American Medical Association (2003)

Herbs as Medicines

"When a patient asks for advice regarding the use of a particular herb, how should a physician respond? Similarly, how does a physician determine if a patient's symptoms are caused by a "remedy"? This review attempts to answer these questions by investigating pertinent definitions, the history of herbs in medicine, epidemiology and prevalence of herbal use, and relevant psychosocial issues." Lisa Corbin Winslow, MD; David J. Kroll, PhD , Archives of Internal Medicine, 1998;158:2192-2199.

Herbal Medicine

Includes origins, safety, effectiveness, green issues and profit. SkepticWiki (The Encyclopaedia of Science and Critical Thinking)