About Herbal Medicines

Introduction

A general disillusionment with conventional medicines, coupled with the desire for a ‘natural’ lifestyle has resulted in an increasing utilisation of complementary and alternative medicine (CAM) across the developed world.

A study of long–term trends in the use of CAM therapies in the United States of America reported that the use of CAM therapies has increased steadily since the 1950s.⁽¹⁾ Use of CAM has increased independent of gender, ethnicity and level of education, but is more common in younger people. The use of herbal medicine increased particularly in the 1970s and then again in the 1990s. The report concluded that the continuing demand for CAM will affect delivery of healthcare for the foreseeable future. Several other studies have documented the growing use of CAM in the United Kingdom, with the most common complementary therapies reported as acupuncture, homeopathy, herbal medicine and manipulative therapies, chiropractic and osteopathy.⁽²⁾

In their report on complementary and alternative medicine, the House of Lords Select Committee on Science and Technology’s Subcommittee on Complementary and Alternative Medicine highlighted the lack of comprehensive information on the use of herbal medicines in the UK.⁽³⁾ Estimates of herbal medicine use are available, but it is difficult to gauge usage accurately as many products are considered to be food supplements. Nevertheless, a national telephone survey of a nationally representative sample of 1204 British adults found that around 7% of those contacted had used herbal medicines in the previous year.⁽⁴⁾ In another survey, over 5000 randomly selected adults in England (not the UK) were sent a postal questionnaire on their use of CAM.⁽⁵⁾ Around 20% of the respondents had bought an over–the–counter herbal remedy in the previous 12 months.

Estimates of expenditure on herbal medicines vary, but data generally show that the global market for herbal products has grown rapidly in the past decade. In the USA, annual retail sales of herbal medicines were estimated to be US$ 1.6 billion in 1994,⁽⁶⁾ and almost US$ 4 billion in 1998.⁽⁷⁾ Retail sales of herbal products in the European Union (EU) were estimated to be US$ 7000 million in 1996.⁽⁸⁾ A detailed analysis of the European herbal medicines market reported that Germany and France make up more than 70% of the market share.⁽⁹⁾ In 1997, total sales of herbal products (using wholesale prices) were US$1.8 billion in Germany and US$1.1 billion in France. In the UK, retail sales of herbal products are reported to have increased by 43% in the period from 1994 to 1998, with retail sales of licensed herbal medicinal products reported to be £50 million in 1998.⁽³⁾

These figures demonstrate that herbal medicinal products are being used increasingly by the general public on a self–selection basis to either replace or complement conventional medicines. Against this background of increasing usage of herbal medicines by the public, several major public health issues have raised concerns about these products. The substitution of toxic Aristolochia species in traditional Chinese medicines (TCM) has resulted in cases of serious renal toxicity and renal cancer in Europe, China and America.⁽¹⁰⁾ The emergence of interactions between St. John’s wort (Hypericum perforatum) and certain prescription medicines has necessitated regulatory action world–wide and has highlighted the need for healthcare professionals to have up–to–date scientific information on the quality, safety and efficacy of these products.⁽¹¹⁾

Pharmacists need to be able to advise the consumer on the rational and safe use of all medicines. To fulfil this role with respect to herbal medicines, a pharmacist should be reliably informed of their quality, safety and efficacy. Also, many other healthcare professionals are becoming increasingly aware of their patients’ use of herbal medicines and need to be informed of the suitability of these products for use as medicines.

In addition to retail purchase, herbs can be obtained by picking the wild plant or from a herbal practitioner.