One of the commonest reasons people query the use of medicinal herbs is that they haven’t been as rigorously tested as pharmaceutical drugs which have undergone random controlled trials [RCTs]. RCTs are supposed to be the gold standard as a stamp of evidence-based-medicine, and therefore a system to be trusted.
I may have beaten this drum before, but I would like to have another bang.
There is so much to say, I don’t know where to start. I will just concentrate on two things.
- There is no universally acceptable gold standard for determining whether a drug safety signal represents a true risk versus a false-positive signal. 1
This is a quote from a paper published by BioMed Central Ltd [part of Springer Nature]. And, as they say of themselves ‘BMC has an evolving portfolio of some 300 peer-reviewed journals, sharing discoveries from research communities in science, technology, engineering and medicine’. So, they ought to know.
What does this mean? At the very least it means that to have a stamp of a RCT on a trial or study does not guarantee that a drug is safe for ill people long term. One of the drawbacks of drug trials is that they are usually done on healthy people to make sure there are no unacceptable side effects. I have not heard of a trial that is maintained for decades, though, which is often the length of time chronically ill people must take drugs.
They go on to say:
‘However, pre-marketing trials are limited in size and duration and exclude high-risk populations. They have limited statistical power to detect rare but potentially serious adverse events in real-world patients.’
- [M]any of these studies likely have biased estimates of treatment effects. In addition, these journals had poor reporting of important methodological aspects.2
And now we come to bias.
I know pharmaceutical companies must make a profit. I know they are answerable to shareholders. I know that they have produced some life-saving drugs and/or procedures. I am not a complementary-system-warrior or anything, but I do protest at some of the inequalities of assessing safety between medicinal herbs and pharmaceutical drugs.
In 2015 I read a book by Ben Goldacre called ‘Bad Pharma’3. He is no friend of herbal medicine [not by a long way] but he revealed the extent to which some drugs have been subjected to advertising hype, have shone in the glow of biased trials, and even slipped through the safety net due to unethical reportage where negative results are hidden to give an unrealistically good outcome for the drug being tested. This made even Dr Goldacre angry, especially his discoveries on the data relating to Reboxetine, which he described as ‘outrageous’.
And I think that a few sentences in the Introduction to Big Pharma is very telling.
‘Drugs are tested by the people who manufacture them… Unsurprisingly, these trials tend to produce results that favour the manufacturer.’
I use medicinal herbs when prescribing for my patients. I teach students about the therapeutic possibilities of using specific herbs and actions in certain conditions. How do I know what to use, at what dose in what condition for each person?
If the herbs I use have not been ‘tested’ in trials, how do I know what works? Or what is safe?
- Thousands of years of usage by intelligent physicians who watched the effect of herbs in different conditions at different dosages in ill people
- Volumes of historical insights into the blending and dispensing of medicinal herbs
- More trials are done on herbs than you might expect [though admittedly not ‘blind’ trials – the taste of liquorice would be hard to mask]
- Using codes of practice incorporated in the membership of professional organisations
- Understanding safe practise with restricted herbs
- Reading modern texts used in the training of medical herbalists, such as:
-The Blending of Liquid Herbs, by Kerry Bone
-The Principles and Practice of Phytotherapy by Simon Mills and Kerry Bone
-The American Herbal Products Association Botanical Safety Handbook
-Botanical Medicine for Women’s Health by Aviva Romm [An MD and herbalist]
-Herbal Medicine in Treating Gynaecological Conditions by Hanaja Brice-Ytsma
-The Essential Guide to Herbal Safety by Simon Mills & Kerry Bone
-Weiss’s Herbal Medicine by R Weiss [MD]
I have had patients warned of the dangers of using certain herbs because it was reported that one person had taken much too much over a short period of time and their liver enzymes had been raised slightly.
And yet, I have had another patient who at the time was undergoing tests on suspicious skin lesions, advised by his GP to accept a pharmaceutical remedy for his arthritis which carried a known risk of provoking skin cancer. When asked why they would do that, the doctor replied, ‘we have nothing else left to give you…’
So, it is OK to prescribe a drug which has the known risk of provoking skin cancer, but not OK to prescribe a mild liver herb because an untrained person once got the dosage massively wrong, and their liver didn’t like it [which is reversible].
Herbs won’t cure everything, and they must be used wisely and not in a scattergun approach. Most people can gain some of this knowledge for themselves and treat minor health conditions successfully. And for the more important stuff there are people like me who have spent years training in both the application of medicinal herbs and in the core medical sciences.
In the UK there are places to train as professional Medical Herbalists, and The School of Herbal Medicine in Somerset is one of them. [Yes, I teach there so I am biased…].
There are professional organisations which monitor courses that produce newly qualified Medical Herbalists, and make sure their training is safe and science-based, and that their members regularly obtain CPD to keep them up with modern developments in disease processes and research. I belong to two of these, one of them is The National Institute of Medical Herbalists [NIMH], and the other is The College of Practitioners of Phytotherapy [CPP].
Dismissing herbal medicine as outdated, unsafe, or unresearched is simply misguided.
1 Sonal Singh, Yoon K Loke. Trials volume 13, Article number: 138 (2012)
https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-13-138
2 Laura E Chess, Joel Gagnier. BMC Medical Research Methodology volume 13, Article number: 76 (2013)
https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-13-76
3 Ben Goldacre. Bad Pharma. Fourth Estate. London. 2012
