Essay Report on the Efficacy and Safety of Herbal Medicine

Abstract

Herbal medicines are products originating from herbs which may have some ingredients with health benefits.  During recent years, there has been a dramatic increase in the use of herbal products as an alternative medicinal treatment around the world.  The efficacy and safety of using herbal medicinal products have been discussed for a long time.  The safety of herbal medicine is a complex issue interrelated to a variety of factors including methods of production, public perception, and attitudes with regards to the products, and the nature of the plants. There are many herbal medicines with the potential for toxicity and problems with contamination.  Furthermore, some herbal medicines may have particular side effects.  Another issue is that herbal medicine lacks a comprehensive, scientific universal standard.

Therefore, regulation of herbal medicine is required to assure consistency between studies and to develop the efficacy and safety of herbal drugs.

Introduction

Herbal medicines have been used for thousands of years.  In the last few decades, there has been significant growth in using herbal medicines, particularly in developed countries like Australia. This report highlights different aspects of herbal medicine including definition, the extent of use, safety and efficacy as well as the potential side effects and adverse reactions.

Description of Herbal Medicine

Herbal medicines are products originating from herb materials which may have health benefits. According to the World Health Organization (2000), ‘herbal materials include leaves, flowers, fruit, seed, stems, wood, bark, roots, and rhizomes’. Any of these given herb materials contain multiple ingredients which can be extracted in different forms like, fresh juices, gums, fixed oils, essential oils, resins, and dry powders.  The preparation of herbal medicine varies in different parts of the world. The production process may include steaming, roasting, stir baking with honey, alcoholic beverages or other materials, (WHO, 2000).

The Extent of Use of Herbal Medicine

The herbal medicine includes a significant proportion of alternative medicinal treatments around the world. As Chan (2003) mentions ‘around 70–8o percent of the world populations rely on non-conventional medicine mainly of herbal sources.’  Despite scientific improvements in conventional medicine and recent innovations in the sector of health services, data indicates a remarkable growth in using herbal medicine in developed countries.  ‘Nearly 1 in 5 adults in the United States report taking an herbal product’ (Bent, 2008). In other developed countries, the extent of use of herbal medicine is also quite high.  As Shaw (1998), states that ‘In 1994 the European herbal medicine market was worth over £1.8 billion at retail selling prices.’

Efficacy of Herbal Medicine

The efficacy of herbal medicinal products has been debated for quite a long time. Scientifically, the efficacy of any herbal remedy requires an evidence-based examination. Scientific examination of several herbal medicines and suggest that the following herbal medicines might have efficiency on specific health problems. Woolf (2003), states that the effectiveness of these three herbal medicines is scientifically approved in these particular treatments: Tea Tree Oil may be useful to remedying fungal skin disorders, Artemisia seems to be associated with chloroquine in the treatment of a specific kind of malaria, and St John’s Wort may help to treat mild depression in adults. Furthermore, according to Myers and Cheras (2004), garlic may reduce blood concentration; however, it may affect other conventional medicines like paracetamol and chlorpropamide. Although the efficacy of some herbal medicine has been examined, the effectiveness of other herbal medicine remains unverified, inadequately observed or not even examined at all.

Safety of Herbal Medicine

The safety of herbal medicine is a complex issue interrelated to different factors including public perception and the nature of plants. As Firenzuoli & Gori (2007) state, some herbal medicines have a foundation in magical or religious beliefs. Furthermore, according to Calixto (2000), most people think herbals are safe because they are natural substances. However, there are un-scientific perceptions and cultural superstitions with regards to using of herbal medicine, but the major circumstances by which the safety of herbal medicines could be affected include, but not limited to toxic hazards, side effects due to interaction with prescription medicine; lack of regulation of herbal medicine; and contamination, adulteration, and overdose usage.

·    Toxic Side Effects

There are many herbal medicines with the potential for toxicity. The degree of toxicity may vary in different herbal medicines. Furthermore, the toxic contaminants can originate from environmental situations as well as the periods and processes of preparation, storage and carriage, (Chan, 2003).  Even though some toxic herbals have been identified, many remain hazardous.  As Calixto (2000), has noted ‘since 1978, more than 4000 herbal medicines have been … marked out because of important toxic effects and risks for human use.’

·     Side Effects due to Interaction with Prescription Drug

There are particular side effects for some kind of herbal medicine. ‘Although herbs are often perceived as “natural” and therefore safe, many different side effects have been reported owing to active ingredients, contaminants, or interactions with drugs’ (Bent, 2008).  According to Ekor (2014), the ordinary side effects associated with Kava vary from headache and dizziness to gastrointestinal discomfort and redness of the eyes.  Even though, side effects may be inherent in some herbal medicine, when taken with prescription drugs there may be serious side effects. In addition, due to the non-prescription availability of herbal medicine, the potential risks of interaction with other drugs, is quite difficult to be documented.  Myers and Cheras (2004) state that patients often do not advise their doctors that they are using herbal products and when combined with prescription medicines the effect can be serious.

·    Regulation of Herbal Medicine

Regulation of herbal medicine is required to assure consistency between studies and to ensure the efficacy and safety of herbal drugs. Regulation of herbal medicine differs based on regions and countries in the world. ‘Several regulatory models for herbal medicines currently exist (Calixto, 2000). In many countries including the United States herbal medicines are sold as a dietary supplement and there is no regulation, while in some other countries like the UK, drug regulations are applicable to some specific kind of herbals products. Global harmonization is essential to assure the efficacy and safety of herbal medicine, which will be achieved through well-controlled and randomized clinical trials and regulation processes (Calixto, 2000).   

·      Contaminated and Adulteration

Herbal medicine can be contaminated in a variety of ways. Primarily contamination accrues during the preparation of herbal medicine, though, contamination can happen in the periods of storage (Shaw, 1998).  The intentional accumulation of extra ingredients with herbal medicine is called adulteration, in which a safe herb may be substituted with a wrong constituent. Contamination and adulteration are potential factors for either study interference in research or serious health effects for patients. Furthermore, there are herbal products which are deliberately manipulated with the purpose of boosting its efficacy. This herbal process is called adulteration. ‘Adulteration complicates adverse reaction monitoring since the wrong plant may be investigated, and documented effects may be associated with the wrong herb, (Shaw, 1998). 

·     Toxicity by heavy metals

Toxicity can be caused by a higher concentration of heavy metals. According to Singh, et al (2011) “Prolonged exposure to heavy metals such as cadmium, copper, lead, nickel, and zinc can cause deleterious health effects in humans. Molecular understanding of plant metal accumulation has numerous biotechnological implications also, the long term effects of which might not be yet known.”

Conclusion

There has been a long history of using herbal medicine, yet, the efficacy and safety of many herbal medicines remain experimental. Even though, a variety of side effects, either intrinsic or extrinsic have been observed, herbal medicine seems to be beneficial for health. Therefore, further research to assess the the efficacy and safety of herbal product is required.   

Recommendations

·       Governments and related institutions should launch a strategic work plan to ensure local regulation of herbal medicine leading to global and international standardization. 

·       Related institutions along with governments should work to raise public awareness regarding the risks and side effects of natural retrieved drugs particularly herbal medicine. This requires a cumulative public awareness campaign, targeting the misperceptions of using herbal medicine, emphasizing neither every natural substance is safe nor every cultural attitude is accurate.  

·       Manufacturers should feature the major side effects on every individual herbal medicine packaging.

·       Further studies and research need to be done aiming not only to find the positive aspects but also investigate side effects of herbal medicine.  In order to conduct further research studies, government should raise funding in this field. 

Acknowledgment

The writer gratefully acknowledges the support provided by the writing teacher, Jenny Parry during the course of preparation of this report.

Reference List

Bent, S. (2008). Herbal medicine in the United States: Review of efficacy, safety, and regulation. Journal of General Internal Medicine, 23 (6). 854-859. doi:10.1007/s11606-008-0632-y.  

Calixto, J. B. (2000). Efficacy, safety, quality control, marketing and regulatory guidelines for herbal medicines (Phytotherapeutic agents). Brazilian Journal of Medical and Biological Research, 33(2),179-189. Retrieved from: http://dx.doi.org/10.1590/S0100-879X2000000200004

Chan, K. (2003). Review Some aspects of toxic contaminants in herbal medicines. Chemosphere, 52. p.1361–1371. Retrieved from: http://faculty.ksu.edu.sa/alqasoumi/Documents/Some%20aspects%20of%20toxic%20contaminants%20in%20herbal%20medicines.pdf

Ekor, M. (2014) The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Frontiers in Pharmacology, 4. doi: 10.3389/fphar.2013.00177

Firenzuoli, F., and Gori, L. (2007). Herbal medicine today: clinical and research issues. Evidence-Based Complementary and Alternative Medicine, 4(1), 37–40. Retrieved from doi: 10.1093/ecam/nem096 

Myers, S.P. and Cheras, P.A. (2004) The other side of the coin: safety of complementary and alternative medicine. Medical Journal of Australia 181(4),222-225.

Shaw, D. (1998) Risks or remedies? safety aspects of herbal remedies in the UK.  Journal of the Royal Society of Medicine, 91, 294-296. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296770/pdf/jrsocmed00024-0008.pdf

Woolf, A, D. (2003) Herbal remedies and children: Do they work? are they harmful? the American Academy of Pediatrics. 112:240. Retrieved from: http://pediatrics.aappublications.org/content/112/Supplement_1/240.full.html#ref-list-1

World Health Organization. (2000). General guidelines for methodologies on research and evaluation of traditional medicine, (1), p.3. Retrieved from: http://apps.who.int/iris/bitstream/10665/66783/1/WHO_EDM_TRM_2000.1.pdf

Traditional and Contemporary Arts of Aboriginals at the Art Gallery of NSW

This is a summary of a lecture given at the Art Gallery of NSW on October 15, 2015.  The topic was Traditional and Contemporary Aboriginal Art.  There were three speakers Marina Smith, Padmini Sampathkumar, and Caroline Storch.

Marina Smith talked about a variety of traditional techniques in which Aboriginal artists illustrated different aspects of their culture. The traditional techniques included wood crafts, waving art, sculptures, and paintings. As mentioned, the majority of Aboriginal artworks are belonging to the time after the 1940s.  Smith also explained the tools, subjects, and geographical area of aboriginal art.  According to Smith, Aboriginal Contemporary Art is mostly constituted by acrylic and canvas and oil.

Caroline Storch explained Aboriginal Traditional Art.  She explained that before 1972 these artworks work not counted as art but as cultural heritage and anthropological testimonials.  According to Caroline, nearly all the Aboriginal arts have a notion of “dreaming”. ‘Dreaming has the same holistic value as the Bible has in Christianity’ she said.  She explained a couple of Bark Paintings. The name of the painting was “Mortuary Rites” and it was painted by Mathaman Marik a famous aboriginal artist.  According to her, there is a remarkable history of thousands of years depicted in those paintings. As mentioned in Aboriginal Art, particularly the Bark Painting dates back before this continent was explored.  She talked about the way they produce barks and other painting materials.  According to Storch Aboriginal, people use a particular tree called Gumtrees to make bark.  She explained they take barks off the gum trees and making it flat by exposing to heat and keeping it under pressure for a long time until the bark become soak and plain.

Padmini Sampathkumar told that the Aboriginal paintings show their rich cultural ceremonies. According to Sampathkumar, the aboriginal artist has dedicated a genuine talent to the entire of their history as there is no written language for them. As mentioned there is a restriction on interpreting those paintings and only the elders are allowed to explain the subjects of Aboriginal artworks.

Impressed by Aboriginal Arts

In the Art Gallery of NSW

On the 15th of October, the English for Academic Purpose (EAP) Class visited the Art Gallery of NSW.  The team was oriented about the traditional and contemporary arts of Australia’s indigenous people (Aboriginals). 

There is no written language for Aboriginals, so they have been telling their entire history by the medium of art.  Aboriginals art is likely to be the world’s first ever paintings.  They started painting on the human body, increasing it on to other materials like rocks, leaves, and barks.

Personally, I was overwhelmed by bark painting. This art has a remarkable history developed during thousands of years. Aboriginal art, particularly the bark painting dates back before this continent was explored.  I was impressed by the way they produce barks and other painting materials.  I observed how they are taking barks off the tree and making it flat by exposing to heat and keeping it under pressure for a long time until the bark get soak and plain. I was also delighted to know about this particular artwork by Mathaman Marik called “Mortuary Rites”. This painting shows the whole grief ceremonial following the death of a member of the family. If one looks closer, it is quite noticeable how aboriginal artist has dedicated a genuine talent to illustrate an event in such details.

Using only two pure naturally retrieved colors, sketching the land and shapes on the bark, and representing symbols of the incredible history of human is the art which brings simplicity and complexity together. The dots are aligned and created the implied lines. This illusionary took me back to thousands of year ago, deep into the ancient Aboriginal lifetime.

Older Generations are Supportive

There has been a long history of families continuing to exist in the traditional shape. Nevertheless, there has been a noticeable change in traditional demographics at the family level in western countries. There are a variety of factors to this demographical change, including growing life expectancy which is likely to be the major factor. However, life expectancy may vary in different regions of the world. As Watkins et al, state ‘there is a 60 percent chance that a 60-year-old female will have a living parent.’  Meanwhile, according to Robertson, she may have grandparents as well. (As cited in Brubaker and Brubaker, 1999). The existence of the older generation within families may provide vital benefits at the society level.

Older generations may have sufficient time to dedicate substantial support and life values to their family members. This may include a wider range of or providing financial support and concerned assistance. The older generation has been exposed to many different conditions, so they may have the potential to provide valuable advice based on their experience. They may also act as the backbone of the entire family. As Healy (2004) describes ‘older people play an important role in supporting and maintaining informal social networks and thus provide the “social glue” that binds three and even four-generation families.’

Despite the perception that the older generation is only beneficiaries not contributor, the fact is that they are the mainstream of support. A survey which was conducted in 1981 in Sydney indicated that ‘older people were more inclined to the providers rather than the recipients of many kinds of support.’ (as cited in Healy, 2004). According to De Vaus & Qu, the data still shows similar results on this issue in recent years as well.

Intergenerational support by old people has been proved by a variety of research, in countries associated with Western families. Studies in the United States show quite similar findings to Australia. Hooyman & Kiyak state that “parents are the most important sources of support for adult children coping with a variety of life crises such as divorce, early widowhood, and grief.” (As cited in Healy, 2004)

The older generation has been proven to provide substantial benefits for families in society. They are the living heritage and an active resource for adult children and younger generations.  Despite the fact of being so beneficial it is more likely that the next generations will not be lucky enough to benefit from the care that the older generation once provided, because families intend to have fewer children.

Reference list

Healy, J. (2004). The benefits of an aging population. Australia Aging Journal. http://www.tai.org.au/documents/dp_fulltext/DP63.pdf

Hodes, R. J. (2011) Changing role of the family. US National Institute on Aging. https://www.nia.nih.gov/research/publication/global-health-and-aging/changing-role-family

Brubaker, T. and Brubaker, E. (1999) the four RS of intergenerational relationships: implications for practice. Family Review Journal 04 (1) pp5. 5-15. http://quod.lib.umich.edu/m/mfr/4919087.0004.102/--four-rs-of-intergenerational-relationships-implications-for?rgn=main;view=fulltext

Essay was written in class on 7/10/15

Herbal Medicine Today: Clinical and Research Issues

Firenzuoli, F., & Gori, L. (2007). Herbal medicine today: clinical and research issues. Evidence-Based Complementary and Alternative Medicine: eCAM, 4(Suppl1), 37–40. Retrieved from doi: 10.1093/ecam/nem096

This is a study of the complicated aspects of herbal research. The study founds that most traditional medicines have a foundation in magical or religious beliefs.  The article argues that relying on tradition is contradicting scientific attitudes, therefore, explanatory and pragmatic studies are needed in the acquisition of reliable data.  The review demands research on both herbal medicines and traditional procedure-based therapies.  In order to achieve this, the article highlights the concepts of efficacy and effectiveness.  Efficacy is defined as the benefit a treatment produces under ideal conditions, while effectiveness defines as the benefit the treatment produces in cumulative clinical practice.  Pragmatic studies are needed in order to examine how effective a treatment is, while explanatory trials are appropriate to asses whether a treatment has any efficacy.  The authors concluded that a world-wide pharmacological assessment needs to be done to clarify the safety of natural-derived substances.  According to the website of Integrative Medicine Florence (n.d.), the authors are academically qualified experts in herbal medicine.  Their target would be primarily medical researchers and clinician examiners but also medical students and the general public.  The study is relevant because it discusses approaches to enhance herbal research methodology.

Risks or Remedies? Safety Aspects of Herbal Remedies in the UK.

Shaw, D. (1998) Risks or remedies? safety aspects of herbal remedies in the UK.  Journal of the Royal Society of Medicine, 91, 294-296. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296770/pdf/jrsocmed00024-0008.pdf

This is a study about the safety of herbal medicine written by Dr. Debbie Shaw.  According to the Uppsala Monitoring Centre website (2008), the author is a Senior Research Scientist at the National Health Service Foundation Trust in London. This study was published by the Journal of the Royal Society of Medicine in 1998.  The study discusses how the safety of herbal medicine is not only bound to quality, but also to usage by consumers, which are categorized as follows: first, use of incorrect herbs; second, delay in getting medical advice for patients who might develop a serious condition; third, the belief by some consumers that natural supplements are healthy; fourth, adulteration of the herbal medicine preparation.  The study is relevant, because the implications of herbal medicine, particularly its safety, is a global issue. The article refers to statistics from the World the Health Organization (WHO) and other major related institutions.  The intended audience would be medical students, the public, clinicians and regulators. The study concludes that there is a lack of communication and information with regards to herbal safety at the global level. The author suggests launching an independent information source combining safety and efficacy data which could be achieved through an adverse reaction monitoring system to be funded by medical and herbal practitioners.  Regardless of having been written almost two decades ago, the main ideas are still relevant and the article includes sufficient sources for further information.