Journals club - Herbal medicines

Dr Louise Newson brings us up to date with the latest research and guidance on herbal medicines.

Research into the efficacy of herbal medicines is generally inconclusive (Photograph: SPL)
Research into the efficacy of herbal medicines is generally inconclusive (Photograph: SPL)

Curriculum statement 1: Being a GP

Key trials

  • A systematic review from the UK found that herbal medicine has been tried by up to 25 per cent of patients with cancer (QJM 2009; 102(12): 831-42).
  • The number of databases and compilations of herbs, herbal formulations, phytochemical constituents and molecular targets is increasing, primarily because of the use of traditional Chinese medicine in combination with drugs (Curr Opin Drug Discov Devel 2010; 13 (1): 50-65).
  • A safety concern of herbal medicine use is the risk of interactions with prescription drugs, which can lead to toxicity or loss of therapeutic efficacy (Pharmacol Res 2010; 62(3): 207-27).

Evidence base

  • One study aimed to clarify the reasons for the use of herbal medicines in the UK. It found that, in comparison with conventional medicine, herbal medicines satisfied expectations of healthcare because it had greater consistency with patients' own understanding about health, illness and healthcare (Complement Ther Med 2009; 17: 300-8).
  • Features of traditional Chinese medicine (such as tailored or individualised medicines) complicate effective undertaking of RCTs of these treatments. This means that data from limited RCTs and systematic reviews should be interpreted with caution (J Altern Complement Med 2010; 16(3): 301-12).

Guidelines

  • Under the Traditional Herbal Medicinal Products Directive, a company needs to demonstrate the safety and efficacy of the herbal medicine through traditional use within the EU for at least 30 years.
  • The MHRA has launched a scheme called the traditional herbal medicines registration scheme, which requires herbal medicines in the UK to be produced under assurances of safety, quality and information for the patient. Any company selling existing herbal medicines that are unlicensed have until 30 April 2011 to register them with the MHRA.
  • In 2009, the DoH held a consultation on the statutory regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems practised in the UK. The consultation is now closed and ministers are considering whether statutory regulation is the most appropriate way of dealing with risks posed by unskilled or unscrupulous practitioners.
Key points
  • Many herbal medicines could interact with traditional medicines.
  • Research regarding the efficacy of herbal medicines is generally inconclusive. More research needs to be done.
  • The DoH is currently considering whether statutory regulation should be in place for herbal and other alternative medicine practitioners.
  • Contributed by Dr Louise Newson, a GP in the West Midlands

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