It is unlikely that any pharmacy today doesn’t stock a few herbal remedies. If only Echinacea, one of the most popular selling herbs of the last decade, used to treat the early signs of colds and winter infections. The last decade has seen a renewed interest in herbs with The House of Lords (Sixth Report 2000) into the use of complementary medicines recording that 34% of people surveyed had used herbal medicine over the past 12 months.
Herbal medicine evolved alongside mankind, with the earliest evidence that man used plants as medicine, not just as food, dating back 60,000 to 80,000 years ago to remains found in the cave tombs of Shanidar, Iraq. In Europe, in 1991, the 5,300 year old Otzi Iceman’s body was found and strung round his waist was the birch fungi Piptoporus betulinus. Birch fungus contains antibiotic and antibacterial properties and may have been used to treat intestinal parasites. Although knowledge of the benefits of herbs was initially passed down orally, the first ‘materia medica’, Pen P’sao The Canon of Herbs, was actually written as long ago as 2698 BC – covering the medicinal effects of some 252 herbs.
Herbal medicine was the primary medicine used throughout the Middle Ages until the development of chemistry and allopathic drugs during the 1500s. There was a pressing need to find a cure for syphilis which was epidemic in Europe at the time. Physicians took the work of Paracelsus, who believed that minute doses of poisonous substances could provide a cure, to the limit. They used arsenic, copper sulphate, iron, mercury, and sulphur, and where minute doses did not work, increased the doses to such an extent that poisoning was a common side effect of treatment. Initially herbal medicine did not seem to have a treatment for syphilis until the discovery of Guaiacum resin from the West Indies.
However, it was not until the early Victorian times, in the 1800s that herbal medicine was replaced as the main form of medicine. Even Boots the Chemist started as a herbal shop. They employed their first pharmacist just 120 years ago, in 1884, when they had started to sell patent medicines alongside their herbal preparations. Herbal medicines were often seen as simples, and as customers could grow them as home, there was not much money to be made in them, unlike chemical preparations. The 20th century has seen incredible advance in pharmaceutical drugs saving many lives and treating many complex conditions.
As our understanding of science has grown, so has the understanding of how herbal medicine works. Many modern drugs have been created from plant material, from Willow Bark, on which Aspirin was modelled – both contain pain-relieving salicylates – to sophisticated drugs such as Paclitaxel, a mitotic inhibitor used in cancer chemotherapy, developed from the Pacific Yew tree. Many clinical studies have also been done on herbs ranging from St. John’s Wort to Saw Palmetto and Ginger. The traditional knowledge of herbal medicines has been kept alive in this country by medical herbalists, often belonging to self-regulating bodies such as the Institute of Medical Herbalists, although formal regulation by the Government is still under review. Research into plants for new drugs has also helped us to understand why herbal medicines work, although the body of published work is still small.
In this last decade, both worldwide and in the UK, there has been a resurgence in the popularity of herbal medicine. In 2007 Mintel recorded an average growth of 9% per annum in the sales of OTC herbal medicines for the previous 5 years and, despite the recent recession, OTC herbal medicine sales have still grown around 3%. This growth goes hand in hand with a decade of increasing interest in organic and natural foods, and a more holistic lifestyle.
The internet has also played a big part. As customers have had more access to health information many are self-educating themselves, and taking a more active role in the management of their own healthcare. Our society also faces a rise in health complaints such as allergies, eczema and hayfever where there are often no short-term solutions, and we experience the natural side-effects of living longer, such as joint pain, prostate problems, etc. Many customers faced with longer term treatment plans, particularly where the conventional drug of choice has unpleasant side-effects, are choosing the more holistic route of herbal medicine.
Herbal medicines, while often slower to act, are generally gentler on the body and tend to have far fewer side-effects than many pharmaceuticals.
One concern many pharmacists have had about selling herbal medicines is that the industry has been unregulated. It has been legal to sell herbal remedies, as they benefited from an exemption, under Section 12(2) of the Medicines Act, from holding a product licence. However, without any form of registration of licence required, there has also been no national quality or safety standards required. While many herbal remedies have been carefully formulated and made under the highest standards, there have been some exceptions which have created health risks for the public. In 2005, the E.U. brought in a new Directive – THMPD (The Traditional Herbal Medicinal Products Directive) and the herbal industry was given 5 years to comply. This means that from 30 April 2011, herbal medicines must hold either a THR registration or a PL licence. Although clinical efficacy is not required for the THR registration, a company must demonstrate traditional use over a minimum 30 year period and submit safety and stability data. Going forward licence holders, wholesalers and manufacturers will all be licensed and regulated, exactly as pharmaceutical companies are, by the MHRA.
From the pharmacist’s point of view, this is good news. Herbal medicines can now be sold with greater confidence. Like a drug, each licensed herbal remedy will be required to have a Patient Information Leaflet stating the approved indication, dosage, any side effects or contraindications and information on overdose. This will make it easier to sell to patients over the counter, and give both pharmacists and G.P.s greater confidence if their customer wishes to try a herbal remedy alongside or instead of an allopathic drug.
It is a mixed blessing for the consumer. On one hand, a licensed herbal remedy provides information and assured safety but on the other hand, as many as 5,000 to 10,000 herbal remedies are likely to be withdrawn from the market. Most herbal companies are small to medium sized companies and the cost of preparing the dossiers has been prohibitive. Only 152 THRs have been applied for to date since the start of the THR scheme (out of which 69 have been passed so far). These THRs also only cover 27 herbs, a far cry from the 252 listed in the Pen P’sao or used in a modern herbal dispensary.
It is inevitable that customer choice will shrink dramatically and it is hoped that this will not lead to an increase in buying unlicensed, and potentially risky, remedies over the internet. There is also some confusion as to when a herb is a medicine or a food. While some such as Ginger or Chamomile are fairly straightforward, others such as Saw Palmetto or Hawthorn Berry are less clear. However, the route for many companies, unable to afford licences, has been to redevelop their herbal food supplement ranges. Until 2011, when the MHRA begins enforcement, the situation is likely to remain fuzzy for a while!
It would be sad to see the vast wealth of knowledge about herbs deteriorate in a restricted market. Plants are still the inspiration for many new medicines like Wormwood (Artemisia) a herb used for centuries that may now yield a new malaria cure and we may face new superbugs and epidemics in the future to which only plants, ever evolving like humans, can provide the answer. For many customers, herbal medicines offer effective results with fewer side-effects in many hard to manage conditions. Luckily the strong popularity of herbal medicines, vitamins and supplements, coupled with the new confidence that the licence offers the modern day pharmacist, will ensure that licensed herbal medicines remain a viable, alternative choice for the future.