By the way... be wary of herbal medicines

DOCTORS are frequently asked by patients to comment on their use of herbal medicines — usually they are looking for agreement that taking a natural remedy is safe, sensible and effective.

Few GPS have had any training in the use of such products, though we’re all aware of many of common ones such as St John’s Wort for depression or echinacea for the common cold or flu. Not only do we lack the training, but I sense many colleagues are sceptical about the value of herbal medicines, particularly in this era of evidence-based medicine.

Yet a little reflection reminds us of the various conventional drugs we use which have been created from herbal products: digoxin, used to tackle heart failure, is a synthetic version of the active compound of digitalis purpurea, the purple foxglove. Morphine and diamorphine, our strongest painkillers, are purified from the opium poppy; the pain of gout is almost instantly relieved — in hours — by colchicine, derived from a type of crocus bulb. There is no question about it: herbal products can work. But the market for herbal medicines has previously been unregulated.

This has led to a variation in quality, and there has been no consumer information supplied with the products on the shelf, so patients and doctors don’t know if there are possible interactions with other medicines.

There have also been worries about the potential for pollutants being included in the herbal tablets or capsules being sold — for example, in 2005 there were reports of liver damage being seen in patients taking Black Cohosh (used for menopausal symptoms), eventually shown to be due to poisonous contaminants.

For these sorts of reasons the European Parliament passed legislation in 2004 allowing the manufacturers of traditional herbal medicines seven years to clean up their act and register their products with ensured purity and safety. The legislation classifies traditional herbal medicines as being those that have been used for at least 30 years and only for indications that are self-limiting minor ailments. The directive insists the products are sold with a patient information leaflet — just as for conventional medicines.

The products that obey these regulations carry a certification mark or logo on the package. The leaflet gives information on when and how to take the treatment, and warnings such as when the medicines should not be used. Despite all that — or because of it — some manufacturers have found it difficult to comply with this law and have side-stepped it by re-classifying t heir herbal medicines as f ood supplements.

They may appear to be a cheaper version of herbal medicines, but there will be no information leaflet, and the reliability, safety, and purity is not to be trusted. This GP’S advice? Avoid.