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Medical School Hot Topic: Herbal Medicines
Herbal medicines have been in use for thousands of years, and it is estimated that more than three quarters of the world’s population rely on traditional herbal medicines as their primary form of healthcare. Over recent years, they have been marketed in the west as both a dietary supplement for the prevention of disease and as an alternative medicine form. Many herbal medicines are readily available in stores across the West, and throughout the world.
Looking at the USA as an example, we find that herbal remedies have gone mainstream. Around one third of Americans use herbal products - some in conjunction with conventional medications, and others using them as a replacement. We should therefore consider that few doctors educated in the Western system are taught about herbal remedies, meaning that their use can be dangerous simply through doctors not understanding the products being used, and therefore the chance of drug interactions, overdose or toxicity. Much of the information on certain herbal medicines still is not translated into English - an issue for those wanting to use the drugs - although clinical reports on the drugs are likely available for physicians.
Investigating Herbal Medicines
Herbal medicines are frequently considered as a treatment for certain lifestyle diseases that will require lifelong medication, with these medications raising concerns over either their safety or over becoming dependent on them. Others believe that herbal medicines are more compatible with the human than Western medicine, as the human has grown and evolved over time with these plants and herbal remedies. Certain phytochemicals in plants are being investigated for direct use in drugs, fuelled by recent work using pure phytochemicals, bioinformatics databases and the advent of libraries that contain examples of pure phytochemicals.
We should therefore look to herbal remedies as a possible source of many new remedies - remedies that will undergo rigorous scientific purification, research, testing and development.
Adverse Effects of Herbal Medicines
There are many possible adverse effects associated with herbal products, attributable to either the herb itself or to other substances added to the medicine by those that produce it. We should therefore be careful of herbal remedies, and look to perform toxicology studies on all ‘herbal’ products - as frequently they may not be as natural as they at first seem.
Conventional drugs are regulated, meaning that they require an extensive process of quality assurance, labelling accuracy, having demonstrated safety and efficacy before marketing, and further extensive surveillance after being released into the market to monitor for adverse effects over time. Conventional drugs must be prescribed, and this prescriber must be trained and educated rigorously in order to prescribe the drug. However, herbal remedies are typically marketed as food supplements, meaning that they require none of the quality assurances that a medical product must go through, and claims on labels can be made far more loosely, with far less regulation.
As it stands, there are still few guidelines on how to demonstrate efficacy or quality of herbal products, meaning that plant materials may be substituted for synthetic products, may contain contaminants, or may simply be entirely mis-labelled - an entirely different plant to what the user expects to buy. Therefore it is not out of the question that a person with a significant health problem might buy a herbal product expecting it to provide a therapeutic benefit (which may be of questionable validity in the first place) and in fact buy a product that does not fit the profile of what they need. They will not have sought proper medical advice, and instead through self-treatment are likely to postpone seeking true medical advice.
There is limited research on the safety profile of these drugs going forward (i.e. little prospective or retrospective information) - whilst generally not potent, they can be if mixed with other medicines, or if taken in higher doses.
What should doctors do?
Doctors should take the time to learn about traditional medicines, and ensure that they keep up to date with any that have a potentially harmful interaction profile. They should ensure to ask patients whether they use alternative therapies, and ensure that any adverse effects linked to herbal remedies are well documented and ideally reported to a central source.
Example Interview Questions
- What are herbal medicines?
- Do herbal medicines work?
- Who might choose to use herbal medicines?
- Herbal medicines are safe to use. True or false?
- Give two potential problems with using herbal medicines.
- Give a potential upside of using herbal medicines
- How many people do you think use herbal medicines?
Interview Questions & Example Answers
What are herbal medicines?
The NHS defines herbal medicines as follows: herbal medicines have active ingredients made from plant parts, such as leaves, roots or flowers.’ It adds that their being natural does not mean that they are always safe to take, that they can affect your body, and that they may be harmful if not used correctly.
Herbal medicines should have a THR (traditional herbal registration) marking on the packaging, that shows that they comply with quality standards for safety and manufacturing, as well as providing an overview of how to use the medicine.
Do herbal medicines work?
Perhaps the safest answer to this question is that they can work. Many have similar active ingredients to prescribed medications, and many certainly can have a profound effect on the body.
Certain trials show an effect from herbal medicines - such as St John’s Wort being confirmed as an antidepressant by an original 23 randomised control trials, and further confirmed by an additional nine trials.
However, one should be careful with herbal medicines - be sure that it is what it is labelled as, that it is well manufactured, and that the dose or amount is correct. Their use should be reported to your doctor as they might interact with other drugs - and a potentially dangerous interaction would not correlate with most people’s idea of a drug ‘working.’
Who might choose to use herbal medicines?
We should be careful of generalising when describing who uses herbal medicines - whilst in the West there might be a preconceived idea of who will use them, in areas of Asia and across Africa up to 80% of the population will rely on traditional herbal medicine as their primary form of health care. In the West or areas where herbal medicine is less common, those that choose it many do so for a variety of reasons. These will include a preference for natural therapies or an interest in alternative medicines, a belief that herbal medicines are more effective than orthodox medicines for diseases or conditions that prescribed medicines have proven ineffective for, a desire to move toward self-medication or distrust of physicians or the wider healthcare service or worries about side effects of orthodox medicines. Generally, herbal medicines are used to treat illness rather than prevent it or promote health.
Herbal medicines are safe to use. True or false?
This depends on the medicine itself, the condition that it is being used for and the context surrounding it. In general, we should be cautious of the safety profile of herbal medicines - they are not manufactured to the same standards as conventional medicines, as they are considered food supplements instead. Therefore, no two medicines will be the exact same, meaning their effects could be different. You may find that you are even taking a different supplement to that which you expected. They can have a profound effect on the body and interact with other drugs that you are using.
However, if used in consultation with a physician, and if the herbal medicine is of good quality and does not interact with other medicines being used, then they may be safe to use.
Give two potential problems with using herbal medicines.
Firstly, conventional drugs are rigorously regulated, and have an extensive process of quality assurance, labelling, and trials to demonstrate safety efficacy before they may be marketed - as well as surveillance after release into the market. However, herbal medicines are classed as food supplements, meaning that they do not have to satisfy these stringent requirements - meaning that their purchaser is far less sure of what they are buying.
Secondly, physicians in the West are trained to prescribe orthodox medicines and will do so with a good knowledge of the medicine, its safety profile, and the other drugs that you may be taking. However, herbal medicines can be taken without a prescription, yet may still interact with other drugs that you are taking - or cause damage by themselves. You should therefore always consult a physician before taking a herbal remedy and ensure that you tell them about any herbal remedies that you are taking when you are prescribed drugs.
Give a potential upside of using herbal medicines
In general, for minor ailments, herbal remedies are fairly well-tolerated by patients and avoid potentially expensive trips to healthcare providers in countries that do not offer free universal healthcare, like the USA.
However, in countries like the UK, we should be careful of encouraging the use of herbal remedies, as a patient using a herbal remedy is a patient that has not sought medical attention - meaning that red flags may have been missed, or that the treatment they have chosen may not be effective.
How many people do you think use herbal medicines?
I believe that a large proportion of the population in the West will use some forms of herbal remedy - be they as dietary supplement, preventative medicine or as treatment. I therefore believe that we should have effective public health campaigns to warn of the benefits and drawbacks of herbal medicines.
Throughout the world, herbal medicines are very popular. In Africa and Asia, up to 80% of the population will rely on herbal medicine, and in India they are so popular that an entire government department - the Medicinal Plants Board - exists to categorise and protect medicinal plants.