FIGURES published last week revealed that sales have risen by almost athird in the past five years, and we're predicted to spend [pounds sterling]191 million oncomplementary treatments this year alone. Many of these Remedies can be boughtover the counterwhich has alarmed medical experts, concerned that some could be toxic and mayput lives at risk. ANGELA EPSTEIN guides you through the competing claims ofsceptics and supporters ...
IF THEY ARE NATURAL, WHY THE CONCERN? HERBAL medicines contain chemicals justlike conventional drugs. The fact they are natural does not mean they are nottoxic, and some are risky, says Edzard Ernst, of Exeter University, Britain'sfirst professor of complementary medicine.
Kava a plant-based remedy used for anxiety, was banned a few years ago after itwas connected with liver problems.
Others remedies may not be toxic but can interact with prescribed medicines.For example, St John's Wortused 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 byrelying 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 workAnother issue is the variable quality of complementary products. 'There ishardly any quality control of herbal remedies, and they are not nearly astightly regulated as conventional medicines,' says Professor Ernst. 'This meansthat some, particularly Asian mixtures, can be contaminated, for instance withheavy metals, or adulterated with prescription drugs.' Denis Gore, aManchester-based community pharmacist who has a special interest incomplementary medicine, suggests it is best to buy alternative products from apharmacy rather than a health food store. 'You will have access to a qualifiedpharmacist who can give you advice about possible interaction between yourchosen 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
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 inthis field explains: 'The problem with herbal medicines is that they may havepharmacological properties, and therefore be subject to the same problems asconventional medicines.
'However, a lack of rigorous trials means we cannot answer the same questionsabout them, such as what is the safe dosage and are all batches of the samepotency?' Pharmaceutical companies have little or no financial interest infunding trialsthe 'gold standard' is the double-blind placebo trial, where one group ofpeople is given the remedy while another is given a dummy preparation. Manyherbal remedies undergo less rigorous testing, and critics claim positiveresults reflect the so-called placebo effectthe 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 clinicaltrials.
One reason for this could be that patients who see an alternative practitioneroften get a lengthy, detailed consultation rather than the rushed few minutesavailable with a GP. This could relieve stress and so make a patient feelbetter. According to Professor Ernst the beneficial effects of the majority ofherbals are totally unproven.
'For instance, research has shown there is no effective herbal remedy forcancer, diabetes, weight loss, multiple sclerosis, osteoporosis, asthma,hangover, hepatitis and many other conditions.' There will always be anecdotalevidence which confounds the results of a clinical trial. For example, theUniversity of Exeter and the Royal Devon & Exeter Hospital carried out aclinical trial on arnicaa popular remedy derived from the Leopard's bane plant used for healing bumpsand bruises. Though tests found it neither reduced pain nor acceleratedhealing, 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 minorsymptoms, such as constipation, without having to prove these claimsprovided the product is proven to be safe.
The fear is that the ready availability of herbal remedies meanslifethreatening illnesses might go undiagnosed, or people discard prescribedtablets in favour of an unproven alternative, says Professor
Ernst. 'For example, constipation could be a sign of bowel cancer, and ifsomeone with treatable bowel cancer buys a homeopathic medicine forconstipation, they may be untreatable tomorrow. Taken to the extreme, thisregulation could cost lives. It cannot be disputed that, in a clinical sense,homeopathy seems to help patients. Yet, scientifically speaking, the remedieshave absolutely no potency.' Until now, there has been no national system toestablish quality and standards in herbal medicine, and the exact contents ofproducts are not always shown on labels.
A new registration scheme, introduced in 2005 regarding herbal products, meanscompanies have to meet quality standards and provide information about thesafety of their product in order to register. However, because there are somany products on the market, manufacturers have until 2011 to meet thelegislation.
SO WHICH REMEDIES WORK? EVEN though many alternative remedies have not been asthoroughly tested as conventional medicines, those that have been shown to workinclude ginkgoa plant extract derived from the Maidenhair Tree, which can help in cases ofdementiaand 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 anatural way to prevent and beat the common cold.
A recent study by the School of Pharmacy at the University of Connecticut foundthat taking echinacea reduced the chances of catching a cold by 58 per cent.However, the results conflict with other studies that show no beneficialeffect.
IS THERE ANYONE WHO SHOULD AVOID HERBAL REMEDIES? PREGNANT women should avoidall alternative remedies, says Professor Ernst as there is no research to showthat any are risk-free and pose no threat to the unborn baby.
Those planning a pregnancy should also take a cautious approach. A recent studyof 818 fertility patients by the University of Copenhagen found that pregnancyrates were about 20 per cent lower among users of alternative medicine.
However, the research couldn't confirm whether complementary medicines have abiological effect or whether the findings reflected the fact that women who usealternative medicine tend to be more stressed by their infertility and may havebeen trying for longer to get pregnant.
There is also evidence that herbal remedies can interfere with theeffectiveness of conventional medicines.
Herbs such as St John's Wort, echinacea, and ginkgo biloba have been found toaffect the recovery of patients after surgery, interfere with prescribedanti-depressants and thin the blood. St John's Wort may also interfere with thecontraceptive pill.
Valerian has been linked to deepening the effect of conventional sedatives,while garlic has blood-thinning properties, so consult your GP if taking itbefore an operation.
Many parents give their children herbal remedies without seeking medicaladvice. A study of 200 children by Thames Valley University found more thanone-third of parents were administering complementary medicineyet 54 per cent did not tell their child's doctor.
However, young children should not be given herbal remedies without a GP'sadvice, says Charles Simenoff, a Manchester-based GP and member of the BritishMedical Association.
If a parent thinks a child has a condition which needs some form of medicalattention, it should be a doctor from whom they get their advice.
'Common sense also has to prevail with anyone, adult or child, who isexperiencing symptoms of any kind that last more than a week. A doctor shouldbe the first port of call in case it indicates a serious problem. Basically, ifsomeone has a health concern they need to see a doctor.' IS THERE A SAFE WAY TOUSE HERBAL REMEDIES? ASK your doctor or pharmacist before you decide to try aherbal supplement, and disclose any medication you are taking. Once you start atreatment, read the label carefully and follow the prescribed dosage. Never tryto 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 theirgoverning body as these organisations exist to maintain high standards ofpractice and patient care. (ANGELA EPSTEIN)