Herbal medicine: There are no safety checks

From Dr Susan Turnbull, Deputy Medical Officer of Health.

A NUMBER of issues raised by Hedi Green (JEP, 11 Jun – Prescription drugs also carry risks) are in need of clarification.

The action taken by Police colleagues earlier this year was in response to a complaint from a customer that a product bought in the Dr Beijing shop listed, as one of its ingredients, the banned substance aristolochia.

This herbal substance was banned in 2002 because of its toxic properties – it causes kidney failure, and cancer of the kidneys. It was important to act quickly to remove any remaining product from sale, as well as to take steps to establish who else may have bought it so they could be contacted to advise against taking any more of it.

The reasons I accompanied police colleagues visiting the shop were twofold: firstly, to seek the co-operation of the Chinese practitioner in voluntarily assisting the police in the interests of public health (and thus avoid the need for arrest); and, with his further cooperation, to have confidential access to client records to establish who needed to be notified of possible risk.

Analysis of the offending product by the UK authorities was a protracted process, linked to a nationwide health alert and investigation of the supplier and other retail outlets. It showed, thankfully, that the amounts present were very low, and harm to health caused by aristolochia unlikely in people who had taken it.

It is not correct, however, to say, as does the title of the article (JEP, 1 Jun), ‘Tests show seized herbal pills posed no risk’. Quite apart from the analysis results with regard to aristolochia, there is no way of knowing whether a herbal product is safe or not. No-one could ever say they pose no risk. That is because herbal medicines are not subject to any safety checks, as are conventional medicines.

Turning to Hedi Green’s comment about adverse reactions to prescription drugs. It is absolutely right to say that all medicines have potential ill effects. This includes herbal medicines.

But there is a big difference. Conventional medicines have to pass rigorous clinical trials and safety checks as part of the legally required licensing process. All potential side effects must be clearly documented for doctors’ and patients’ information, as well as the potential of the medicine/drug to interact with others. Information must also be provided about any cautions or contra-indications (when it should not be used, or used only with caution and careful monitoring).

Each time a doctor reaches a balanced decision to recommend a medicine and prescribe it, he or she is doing so in the knowledge of the potential benefit to each patient, as well as any potential harms which should be discussed.

Doctors, in order to be licensed by the General Medical Council to practise medicine, need to have up to date professional indemnity. In the event of any successful legal claim in negligence, for instance, the organisation providing indemnity pays damages on the doctor’s behalf.

Neither herbal products, nor herbal practitioners come with any such assurances. The quality, safety, and possible side effects of these products are entirely unknown, apart from the few known poisons, such as aristolochia. Neither herbal medicines, nor herbal practitioners are subject to any regulation. It is simply a case of ‘buyer beware’.

Which makes it all the more important for authorities to act quickly to protect public health, if there is evidence indicating that a poisonous substance is on sale in our town centre. Imagine the criticism if no action had been taken, especially once the product recall was in the national news.

Formerly, legal highs were marketed on the basis that if something is natural, herbal, and not actually illegal then that should somehow make it safe. Not so, as growing evidence indicates. Remember, some of the most potent poisons known to man – strychnine, belladonna, aconite, hemlock – are herbal.