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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)
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]
"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)
"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]
An article looking at the risks to children posed by herbal medicine and other CAM therapies. Edzard Ernst, The Guardian (14th June 2005)
Report in Focus on Alternative and Complementary Medicine [FACT] (September 2006)
“Undercover US government employees received consistently false information when shopping for supplements, and analyses show most supplements contain trace amounts of contaminants.” Scientific American (28th May 2010)
“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 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)
"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.
“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)
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)
"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)
Concludes that interactions between herbal medicines and synthetic drugs exsit and can have serious clinical consequences. Drugs (2001)
The concomitant use of herbal medicines and pharmacotherapy is wide spread. This review of the literature determines the possible interactions between seven popular herbal medicines (ginkgo, St John's wort, ginseng, garlic, echinacea, saw palmetto and kava) and conventional drugs. Izzo AA, Ernst E. Drugs (2009)
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)
"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)
"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)
“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)