Germany and France lead herbal use in Europe

In 2003, German health insurance providers reimbursed US$283 million for prescriptions of ginko, St John's wort, mistletoe, saw palmetto, ivy, hawthorn, stinging nettle root, myrtol, phytosterols and curcurbita.

French insurers paid out $91 million in partial reimbursements for ginko, saw palmetto and pygeum, with a total value of $196 million.

Almost $5 billion (at manufacturers' prices to wholesalers) was spent on over-the-counter herbal medicines in all European countries in 2003.

At the other end of the scale, herbal medicines are generally not covered by the UK's National Health Service and few general practitioners prescribe them - although herbal practitioners are permitted to sell unlicensed herbal products after consultation with a patient.

Nonetheless, industrial herb preparations must conform to the same requirements as conventional medicines in the UK - a principle that means most herbal products cannot be licensed and are therefore without regulatory control.

France and Germany, on the other hand, have introduced simple registration procedures that do not require firm proof of efficacy.

The report's author Dr Peter De Smet noted that two recent EC directives have sought to bring these differences into alignment. The first, passed in 1999, allows those seeking authorization to bring products to market to draw on published scientific data demonstrating established medicinal use, efficacy and safety, without the need for new preclinical tests and clinical trials.

In March 2004 the second directive created a procedure whereby herbal medicines that have enjoyed long use but do not fulfill the requirements to be classified as well-established medicines may be registered, subject to certain criteria.

De Smet said that the European legislation, although it does have some drawbacks - such as dispensing with the need for scientific proof of efficacy as long as they are used for minor ailments and labelled as 'traditionally used' - is, by and large, helpful.

He calls it "an inspiration for anyone striving for better regulation of herbal products in the United States"​.