Madhab K. Chattopadhyay
Importance of herbal medicines
The plant kingdom is a vast repository of medicinal substances. The healing potential of plant-derived chemicals was aptly appreciated by people in the ancient civilizations. That is why a substantial portion of the traditional medicines was obtained from plants. With the rapid progress in the areas of synthetic chemistry, fermentation technology and recombinant DNA technology, herbal medicines still useful in various ways. Herbal drugs are believed to bear the strongest to be relegated to a back seat in the present-day therapeutics but they are potential to complement (but not to compete with) the western medicines. Therefore it is not surprising that sometimes even the practitioners of allopathic medicines found to include herbal formulations into their prescriptions. Some chronic ailments (e.g asthma, arthritis) have no radical cure in allopathic system of treatment. People, who are suffering for a long time from these problems, tend to seek relief in alternative medicines, a sizeable fraction of which is contributed by herbal medicines. The importance of alternative remedies is also being appreciated in view of the failure of some allopathic medicines like antibiotics because of widespread emergence of pathogenic organisms immune to them. According to a recent estimate, three quarters of the world population use herbal and traditional remedies as a basis of primary health care. In a country like ours, populated by millions of poor people, western medicines remain out of reach of a sizeable portion of the citizens. Hence, "health for all" will remain a promise merely on paper until and unless we tap the vast resources of plant medicines available right in our surroundings.
Problems associated with the use of herbal medicines
- Contamination with harmful plants: However, the use of herbal medicines is associated with some problems. First of all, the medicinal plant has to be correctly identified. Any mistake at this step may lead to irreversible health damage of the user. During the 1990s, an increasing number of young women with different degrees of kidney failure were found approaching nephrologists in and around Brussels. It was revealed that all of them ingested a medicine obtained from a slimming clinic. The medicinal plant was inadvertently mixed with another plant which was damaging to the kidneys. It contained aristolochic acid which is known to be carcinogenic. Some of the patients had to undergo dialysis and even kidney transplantation. While performing operations, the surgeons observed that some of them had symptoms of cancer in their kidneys.
-
Problem in correct dosing: Amount of active ingredients in the plants varies depending on several factors viz age of the plant, season during collection of the plant products. Hence, somebody using a herbal medicine for months or years, may not get the same amount of active substance in a certain dose taken from different batches of the same formulation.
-
Presence of toxic substances: Herbal medicines are also likely to be contaminated with toxic metals (e.g lead, mercury). Reports on metal toxicity associated with the use of herbal medicines appear in the medical journals from time to time. Besides toxic metals, other types of toxic substances present in the plant bodies (e.g. curare, ricin) may also lead to serious problem to the users.
-
Problem with other ingredients: The vehicle used to administer herbal medicines may also pose health risk to the users. Every year thousands of asthmatics from all over India and the neighbouring countries throng in Hyderabad on a particular day of June to get a traditional remedy, distributed free of cost. The remedy is put into the mouth of a live fish belonging to the genus Channa and the patient is forced to swallow the fish with the medicine. A couple of years back, researchers in the Zoology Department of Andhra University collected some samples of the fishes used for administration of the medicine and detected a number of pathogenic parasites in the fishes.
-
Intentional addition of allopathic medicines: Another problem associated with the use of herbal medicines is the admixture of the traditional remedies with allopathic medicines. Some dishonest manufacturers of herbal medicines add high dose of steroids and other allopathic medicines in order to improve the efficacy of their products. Patients unknowingly ingest a lot of allopathic medicines in unregulated doses and have to suffer from the adverse effects.
-
Interaction with allopathic medicines: Some patients tend to use western and herbal medicines simultaneously without informing their physicians. The contents of the herbal formulations may have dangerous interaction with the western medicines, either augmenting or suppressing their effect. Research on "Herb-drug interaction" is being conducted at many laboratories all over the world at present.
-
Paucity of information: Lack of sufficient information on the herbal products also may lead to serious consequences. When a patient arrives at the hospital with a suspected case of toxicity, it is essential for the physicians to know the nature of the toxic substance that has entered his body. It is most often not possible in case of herbal toxicity since the labels of the products in many cases are printed in obscure languages (e.g, Chinese) with insufficient information. A couple of years back, a patient was bought to the Northwick Park Hospital (Middlesex, UK) with injuries. He jumped from an upper floor room out of an imaginary fear that some people were going to attack him. He was reported to use a herbal formulation dubbed "Ma Huang" which was claimed to calm the mind and stimulate the body while inducing loss in body weight, in the advertisement published in a magazine. It was known to contain ephedrine, which could induce psychosis. But the leaflet supplied with the formulation had no mention about ephedrine. In another case, a 27-year old young man admitted to the hospital with hepatic failure, was known to take a herbal formulation named "Eternal Life". Inquiry with the manufacturer revealed that several types of substances were dispensed under the same brand name and hence it was not possible to ascertain what was there in the formulation ingested by that man.
A global problem
In a country like the US, where barring a few medicines, it is not possible to buy any other medicinal product without a prescription, people can freely buy any herbal medicine since all herbal formulations, though regulated by the Food and Drug Administration, are sold under the category of "dietary supplements". Before being marketed, all medicines have to pass through the rigorous testing for efficacy and safety. Herbal medicines, by and large, escape such quality control since most of the manufacturers find it too costly to maintain the research infrastructure required for the testing of their products. Consequently, people are falling victims to the herbal toxicity. As a whole, problems caused by unregulated herbal medicines have posed a serious threat to the health care system in the developed and developing countries alike. People are allured into thinking that herbal medicines are intrinsically safer than synthetic medicines and they are the magical the geriatric problems. cures for everything ranging from juvenile to Notwithstanding the fact that available evidences hardly support their wishful thinking, the self-prescribed use of herbal remedies has resulted in a boom in the sale of such drugs all over the world.
Concluding remark
This discussion does not intend to discourage anybody from using herbal medicines. But the origin of any medicinal product should be carefully looked into before buying it. Only those, bearing a proper label and marketed by reputed manufacturing companies, should be chosen for use. Products of obscure organizations with lofty claims should be avoided.
Suggested for further reading
1) Ensuring safe use of herbal drugs, Chattopadhyay MK, In GMP for Botanicals, Mukherjee P, Verpoorte R (Ed), Ch :13, pp: 231-236, Business Horizon, New Delhi, India (2003)
2) Herb poisoning. Barrueto F, Jr, Medscape http://emedicine.medscape.com/article/817427-overview(updated January 10, 2014)
3) Herbal medicines, University of New Hampshire, Office of Health Education and Promotion Practices http://www.unh.edu/health-services/ohep/complementaryalternative-health-practices/herbal-medicine
4) Toxicities by herbal medicines with emphasis to traditional Chinese medicine. Efferth T, Kaina B. Curr Drug Metab. 12:989-996 (2011)