Putting herbals into perspective
with synthetic drugs, argues a British Medicial Journal
editorial out tomorrow. And failing to fund further studies on
herbals represents the biggest risk to consumers, Edzard Ernst
concludes.
The use of herbal medicines entails risks, but probably fewer than with synthetic drugs, argues an expert in a British Medicial Journal (BMJ) editorial out tomorrow.
Several stories hitting the headlines in recent weeks have alerted consumers to the dangers of taking herbal medicines, and the industry could see a dip in consumer spending. A new study found that ginseng may affect the foetus while researchers at a recent pharmacists' conference warned of the side effects of taking herbal remedies alongside prescription drugs. But the benefits of herbals most likely outweigh their potential for harm, argues Edzard Ernst, director of complementary medicine at the University of Exeter's Peninsula Medical School.
"The potential benefits of herbal medicines could lie in their high acceptance by patients, efficacy, relative safety, and relatively low costs," Ernst writes.
The author points to the major growth in herbal medicines worldwide over recent years. In the United Kingdom, herbal medicine has been tried by about 30 per cent of the British population, who now spend around £31 million (€45m) annually on plant-based remedies. Germans spend up to £1.3 billion on herbals. This acceptance may prove one of the strengths of medicating with herbals.
Ernst also argues that the efficacy of such treatments, increasingly under scrutiny, may be hampered by new regulation and lack of resources in the industry.
"Sadly the traditional use directive, which sets out to harmonise the registration of herbal medicines in the European Union, lacks any incentive for companies to invest further into research. Public funds are only very rarely dedicated to research in this area."
He adds: "The relative paucity of rigorous clinical trials is mostly due to the fact that, compared with the pharmaceutical sector, the herbal industry is small and can rarely afford the considerable expense of a clinical trial."
But the safety of herbals, an increasingly controversial subject, could be further supported by better fundings, argues the author. Ersnt notes that between 1968 and 1997, the World Health Organization's monitoring centre collected 8985 reports of adverse events associated with herbal medicines from 55 countries. A large number, but "only a tiny fraction" of adverse events associated with conventional drugs held in the same database.
Furthermore conclusive evidence on the relative risks of herbal medicine versus synthetic drugs is scarce. Previous Peninsula Medical School research shows that kava is probably still safer than benzodiazepines, although the plant has now been banned widely throughout the European Union.
"At present the relative safety of herbal medicines is undefinable, but many of the existing data indicate that adverse events, particularly serious ones, occur less often than with prescription drugs," continues the editorial.
Yet despite studies warning of the risks of herbals, consumers seem to show no signs of changing the current trend. This increases pressure on healthcare professionals to be well informed about the subject, argues Ernst, and on researchers "to fill the many and somewhat embarrassing gaps in our current knowledge".
"Failing to do (and fund) this work would, in my view, constitute the true risk associated with herbal medicines," he concludes.
