by ANGELA EPSTEIN
Figures published last week revealed that sales have risen by almost a third in the past five years, and we’re predicted to spend ?191 million on complementary treatments this year alone. Many of these remedies can be bought over the counter - which has alarmed medical experts, concerned that some could be toxic and may put lives at risk. ANGELA EPSTEIN guides you through the competing claims of sceptics and supporters…
IF THEY ARE NATURAL, WHY THE CONCERN?
Herbal medicines contain chemicals just like conventional drugs. The fact they are natural does not mean they are not toxic, and some are risky, says Edzard Ernst, of Exeter University, Britain’s first professor of complementary medicine.
Kava a plant-based remedy used for anxiety, was banned a few years ago after it was connected with liver problems.
Others remedies may not be toxic but can interact with prescribed medicines. For example, St John’s Wort - used for depression - interferes with at least 50 per cent of prescribed drugs.
Medical experts also fear that some people may put their lives at risk by relying on complementary rather than sound medical treatment.
Some alternative medicine clinics sell homeopathic protection against malaria, despite clear Government advice that there is no evidence such treatments work Another issue is the variable quality of complementary products.
“There is hardly any quality control of herbal remedies, and they are not nearly as tightly regulated as conventional medicines,” says Professor Ernst.
“This means that some, particularly Asian mixtures, can be contaminated, for instance with heavy metals, or adulterated with prescription drugs.”
Denis Gore, a Manchester-based community pharmacist who has a special interest in complementary medicine, suggests it is best to buy alternative products from a pharmacy rather than a health food store.
“You will have access to a qualified pharmacist who can give you advice about possible interaction between your chosen complementary medicine and standard medication or medical conditions. They are also likely to stock reputable brands whose contents can be trusted.”
IS THERE ANY PROOF THAT HERBAL REMEDIES WORK?
Even if a herbal remedy is safe, that doesn’t mean it works. As Dr Cath White, a GP with a special interest in this field explains: “The problem with herbal medicines is that they may have pharmacological properties, and therefore be subject to the same problems as conventional medicines.
“However, a lack of rigorous trials means we cannot answer the same questions about them, such as what is the safe dosage and are all batches of the same potency?”
Pharmaceutical companies have little or no financial interest in funding trials - the ‘gold standard’ is the double-blind placebo trial, where one group of people is given the remedy while another is given a dummy preparation.
Many herbal remedies undergo less rigorous testing, and critics claim positive results reflect the so-called placebo effect ? the patient ‘feels better’ - rather than sound clinical proof.
A Swiss study published in The Lancet in 2005 suggested that the benefits of homeopathy are all in the mind, with alternative remedies performing no better than dummy pills in clinical trials.
One reason for this could be that patients who see an alternative practitioner often get a lengthy, detailed consultation rather than the rushed few minutes available with a GP. This could relieve stress and so make a patient feel better.
According to Professor Ernst the beneficial effects of the majority of herbals are totally unproven.
“For instance, research has shown there is no effective herbal remedy for cancer, diabetes, weight loss, multiple sclerosis, osteoporosis, asthma, hangover, hepatitis and many other conditions.”
There will always be anecdotal evidence which confounds the results of a clinical trial.
For example, the University of Exeter and the Royal Devon & Exeter Hospital carried out a clinical trial on arnica - a popular remedy derived from the Leopard’s bane plant used for healing bumps and bruises.
Though tests found it neither reduced pain nor accelerated healing, many patients claim it works.
A further complication arises from the labelling of homeopathic medicines.
Manufacturers are allowed to claim their products help to relieve minor symptoms, such as constipation, without having to prove these claims - provided the product is proven to be safe.
The fear is that the ready availability of herbal remedies means lifethreatening illnesses might go undiagnosed, or people discard prescribed tablets in favour of an unproven alternative, says Professor Ernst.
“For example, constipation could be a sign of bowel cancer, and if someone with treatable bowel cancer buys a homeopathic medicine for constipation, they may be untreatable tomorrow. Taken to the extreme, this regulation could cost lives. It cannot be disputed that, in a clinical sense, homeopathy seems to help patients. Yet, scientifically speaking, the remedies have absolutely no potency.”
Until now, there has been no national system to establish quality and standards in herbal medicine, and the exact contents of products are not always shown on labels.
A new registration scheme, introduced in 2005 regarding herbal products, means companies have to meet quality standards and provide information about the safety of their product in order to register. However, because there are so many products on the market, manufacturers have until 2011 to meet the legislation.
SO WHICH REMEDIES WORK?
Even though many alternative remedies have not been as thoroughly tested as conventional medicines, those that have been shown to work include ginkgo - a plant extract derived from the Maidenhair Tree, which can help in cases of dementia - and flowers and leaves from the hawthorn plant - for treating heart failure.
Opinion remains divided on popular remedies used for more routine conditions. For example, products containing the echinacea flower have been championed as a natural way to prevent and beat the common cold.
A recent study by the School of Pharmacy at the University of Connecticut found that taking echinacea reduced the chances of catching a cold by 58 per cent. However, the results conflict with other studies that show no beneficial effect.
IS THERE ANYONE WHO SHOULD AVOID HERBAL REMEDIES?
Pregnant women should avoid all alternative remedies, says Professor Ernst as there is no research to show that any are risk-free and pose no threat to the unborn baby.
Those planning a pregnancy should also take a cautious approach. A recent study of 818 fertility patients by the University of Copenhagen found that pregnancy rates were about 20 per cent lower among users of alternative medicine.
However, the research couldn’t confirm whether complementary medicines have a biological effect or whether the findings reflected the fact that women who use alternative medicine tend to be more stressed by their infertility and may have been trying for longer to get pregnant.
There is also evidence that herbal remedies can interfere with the effectiveness of conventional medicines.
Herbs such as St John’s Wort, echinacea, and ginkgo biloba have been found to affect the recovery of patients after surgery, interfere with prescribed anti-depressants and thin the blood. St John’s Wort may also interfere with the contraceptive pill.
Valerian has been linked to deepening the effect of conventional sedatives, while garlic has blood-thinning properties, so consult your GP if taking it before an operation.
Many parents give their children herbal remedies without seeking medical advice. A study of 200 children by Thames Valley University found more than one-third of parents were administering complementary medicine - yet 54 per cent did not tell their child’s doctor.
However, young children should not be given herbal remedies without a GP’s advice, says Charles Simenoff, a Manchester-based GP and member of the British Medical Association.
If a parent thinks a child has a condition which needs some form of medical attention, it should be a doctor from whom they get their advice.
“Common sense also has to prevail with anyone, adult or child, who is experiencing symptoms of any kind that last more than a week. A doctor should be the first port of call in case it indicates a serious problem. Basically, if someone has a health concern they need to see a doctor.”
IS THERE A SAFE WAY TO USE HERBAL REMEDIES?
Ask your doctor or pharmacist before you decide to try a herbal supplement, and disclose any medication you are taking. Once you start a treatment, read the label carefully and follow the prescribed dosage. Never try to self-medicate for serious conditions such as diabetes.
And stop taking any remedy immediately if you have any kind of reaction.
If you want to see an alternative practitioner, find one through their governing body as these organisations exist to maintain high standards of practice and patient care.
Try the National Institute of Medical Herbalists (tel. 01392 426022); The Society of Homeopaths - the largest organisation registering professional homeopaths in Europe (tel.0845 450 6611); or The Institute for Complementary Medicine (tel. 020 7231 5855).
Source: the Daily Mail
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