More control sought on herbal cures

STRICTER CONTROLS should be imposed over the sale of herbal remedies because of the dangers of possible side-effects, according to scientists involved in studying the potential benefits of traditional medicines.

Many herbal remedies are sold as food supplements, enabling manufacturers to bypass the regulations imposed on licensed plant products.

The Government is under pressure from the European Union to tighten the sale of such remedies and the Department of Health has asked the Medicines Control Agency to review new control measures.

Baroness Hayman, a Health minister, yesterday announced a period of consultation before the Government took action. "The present regulatory arrangements have some limitations," she said.

"There is a sharp contrast between the rigorous requirements to demonstrate safety, quality and efficacy which apply to licensed herbal medicines, and the limited regulatory requirements which apply to unlicensed herbal medicines."

Professor Edzard Ernst, head of complementary medicine at Exeter University, told a scientific meeting in London that there was little excuse for treating herbal remedies any differently from other medicines with proven benefits.

There has been nearly a four-fold increase in herbal treatments in the US since 1990 and although no similar figures are available in Britain, Professor Ernst said that anecdotal evidence suggests traditional medicine is experiencing a similar increase in popularity.

Professor Ernst said existing controls were not enough. "The present situation is unsatisfactory because it doesn't guarantee that the consumer is protected. There are certain side-effects from herbal remedies and a lack of control invites all sorts of cowboy behaviour," he said.

The World Health Organisation has registered about 9,000 cases of side- effects caused by people taking herbal remedies, mostly caused by allergic reactions or the effects of contamination and adulteration.

Bart Halkes, an expert in herbal remedies at the University of Utrecht, said many traditional medicines are inherently impure products.

"Contaminants most likely to be found in crude medicinal herbs include heavy metals such as lead, mercury and cadmium, pesticides or herbicides, microrganisms and also microbiological toxins, such as afflotoxin, and radioactive isotopes," Dr Halkes said.

Deliberate adulteration, due to either incompetence or ignorance, is also a problem, he said. "Adverse reactions may also be due to the use of concentrates or specifically processed extracts of plants which are know to affect the uptake of other drugs in the body."

Elizabeth Williamson, who studies the effects of herbal remedies at the University of London, said there was no such thing as an effective medicine that did not have side-effects.

"There should be more control over unlicensed herbal medicines. The trouble is that people are selling any old rubbish as a food supplement," she said.

The aromatherapy debate, Health, Review, page 11

FIVE POPULAR HERBAL REMEDIES

GINKGO BILOBA

WHAT IS IT, WHERE IS

IT FOUND?

Old Chinese tree, but grows abundantly around the world. The leaves are used as a medicine

WHAT IS IT SUPPOSED TO DO?

Traditionally associated with relieving circulatory disorders. More recently, said to help to slow the onset of senile dementia. Contains a number of active ingredients

IS THERE

EVIDENCE

IT WORKS?

Good anecdotal evidence to ease problems with blood system. Clinical trials in Germany and US indicate a positive effect in averting the symptoms of Alzheimer's disease

ARE THERE SIDE

EFFECTS?

Hardly any. Occasional allergy problems. May react with blood-thinning drugs used on patients with heart disease

KAVA

WHAT IS IT, WHERE IS

IT FOUND?

Root of the pepper plant, comes from the South Seas islands, notably Fiji

WHAT IS IT SUPPOSED TO DO?

Used traditionally as a recreational drink because of its relaxing properties. A known psycho-active drug, it is currently being studied as a possible anti-depressive

IS THERE

EVIDENCE

IT WORKS?

At least 10 clinical trials indicate that it is better than a placebo and as good as some mild tranquillisers at calming anxiety symptoms

ARE THERE SIDE

EFFECTS?

Mild stomach upsets, and probably not to be used with synthetic tranquillisers

ECHINACEA

WHAT IS IT, WHERE IS

IT FOUND?

Small flowering plant from North America. Any part may be used, but mostly the roots

WHAT IS IT SUPPOSED TO DO?

Supposed to be a general tonic. Said to boost the immune system by stimulating the white blood cells. Could help to prevent colds and simple infections

IS THERE

EVIDENCE

IT WORKS?

Some evidence, mostly anecdotal and controversial. Some trials show it works, others indicate it has no effect. The jury's out

ARE THERE SIDE

EFFECTS?

Gastro-intestinal upsets; quite dramatic allergic reactions reported in some people

SAW PALMETTO

WHAT IS IT, WHERE IS

IT FOUND?

A cactus-like plant. Grows in hot, dry climates. Used by native Americans

WHAT IS IT SUPPOSED TO DO?

Supposed to help alleviate the symptoms of benign prostate problems in men, who have difficulty urinating. Scientists are still trying to work out how it works

IS THERE

EVIDENCE

IT WORKS?

No question that it works, say the experts. Clinical trials show an unequivocal benefit to men with prostate disorders

ARE THERE SIDE

EFFECTS?

Virtually none. A potential winner, according to some experts

ST JOHN'S WORT

WHAT IS IT, WHERE IS

IT FOUND?

Grows just about everywhere in mild, damp climate, such as Britain's. Shrub with yellow flowers

WHAT IS IT SUPPOSED TO DO?

Supposed to help mild or moderate depression. Traditionally used as a tonic, and a treatment for mood disorders. Unclear what the active ingredients may be

IS THERE

EVIDENCE

IT WORKS?

About 20 trials conducted that indicate there is good reason to believe there is something to the anecdotal reports

ARE THERE SIDE

EFFECTS?

Mild stomach upsets, and a theoretical risk of skin problems when exposed to sunlight