I’m not a pharmacist but off the cuff i can think of several medicines that are in general use and were derived from plants.

To give a few – Asprin, Quinine and Curare. Asprin everybody knows about. Quinine is (or was…anybody?) an anti malaria drug and curare is a muscle relaxant, which is so effective it’ll relax you to death if your not careful, used in surgical prep.

The main problem with herbal, as pointed out above, is quality control.

Thanks for correcting me – very interesting

I had always assumed herbals were much more regulated in (say) Germany than in the UK mainly since (i) the Germans are into heavy regulation of the health sector (including CAM) than we are; and (ii) herbals are so widely prescribed there by doctors (e.g. St J’s Wort for mild depression)… so figured people selling herbals there would have to have much more stringent quality control and product info.

I have noticed that here in the UK certain herbal formulations have much better info than others – e.g. for St J’s W again, Kira that Boots sell (which is made by Lichtwer Pharma, a big German company you probably know) has stuff like “equivalent to xx ug hypericin” and a full side-effects leaflet. But if I walk to the local Health Food superstore they have loads of different brands of SJW and a health-food salesperson who says “oh, this one is good” and sells me/you a bottle with minimal info.

I would be interested to hear your views on the “comparability” of the regulations (if any) on product quality / included product info for mainstream pharmaceuticals and herbals.

Going back to your original point, I would have predicted that adverse side-effect reporting would be less with (e.g.) herbals simply because they don’t come from the GP/hospital like mainstream stuff does, which provides a contact point and “avenue” for reports of side-effects of pharmaceuticals to go back to MHRA. Does your experience shed any light on this?

There is somewhere for adverse reactions to herbal medicines to be reported – The MHRA. I should know, I was the herbals officer (for my level) there for a while.

Also, herbals aren’t technically unlicensed, genuine traditional ones can just get an automatic license and don’t have to do anything to get it other than apply (well, I hink they have to show the quality of the product, but other than GMP there’s nothing).

The one area where they are (in theory at least) regulated is in advertising. Herbal peddlers have to include an invitation to always read the product leaflet or similar (www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&nodeId=600), but rarely do.

I’ve noticed that adverts for herbals in general almost always fail to comply with the lenient requirements in the blue book (available for download from the above link) and have started complaining to the MHRA (not that they seem to have done anything about it yet).

www.ucl.ac.uk/Pharmacology/dc-bits/quack.html#univ

Go David.

I have a slightly crazed vision of a Buffy’s gang-style crew of Alt Medicine Slayers. Ben isn’t really blonde enough for Buffy so perhaps he will have to be cast as Xander, plenty ofooprtunities for witty quips. David Colquhoun would be a shoo-in for the Giles role.

Think I need to lay off the strong coffee in the afternoon.

Presumably the columnists are “geared” to writing positive stories: “you could try this” “This might do some good” “read this helps” etc etc. Harder to say “nothing you can do expect eat healthy and take exercise”, they would just keep repeating themselves.

“Negative results are always harder to publish than a good “this could be something” result”

.. at last – a parallel between science and Alt Health!

Dr Ben Goldacre*
Bad Science Research Institute,
www.badscience.net
tips@badscience.net
*Corresponding Author

Introduction.

Susan Clark is an alternative therapy columnist who yesterday made a barbed attack on her critics. It has been noted that she promotes one company, Victoria Health, with some regularity. It was unclear what the background frequency of this company being promoted in newspapers was.

Methods.

Since I couldn’t be bothered to cycle to the Guardian and go through all the newspaper archives systematically, I had a quick look at each newspaper’s archives through publicly available resources, as a pilot study.

Results.

Victoria Health are promoted in the following newspapers and circumstances:

# You magazine (with which they have an explicit commercial relationship)

# by Susan Clark (dozens and dozens)

# by Emma Mitchell in the Guardian. [anybody know if she has a relationship with them?]

From this brief survey, several interesting negative findings also arose. No mention of Victoria Health could be found in other newspapers. Specifically, there were:

# no mentions in the Express:

www.google.co.uk/search?num=100&hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&q=+site%3Awww.express.co.uk+%22victoria+health%22+&btnG=Search&meta=

# no mentions in the Independent:

www.independent.co.uk/search/simple.do?publicationId=55&includeSectionId=38&xsuccessUrl=index.jsp%3FtemplateName%3Dresult&xerrorUrl=index.jsp%3FtemplateName%3Dresult&searchEngineName=lucySearch1&includeSubSections=true&pageLength=25&articleType=news&sortString=by_date_desc&maxRows=500&searchString=%22victoria+health%22

# no mentions in the Telegraph:

www.google.co.uk/search?num=100&hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&q=+site%3Awww.telegraph.co.uk+%22victoria+health%22+&btnG=Search&meta=

# no mentions in the Daily Mail (from google alone) except once briefly in the context of an explicit commercial relationship:

www.google.co.uk/search?num=100&hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&q=+site%3Awww.dailymail.co.uk+%22victoria+health%22+&btnG=Search&meta=

If she had the slightest brain or sense or compassion, she would tell the poor sod to go and see their doctor and tell them what has happened. The doctor could then prescribe a different medication.

Hopefully, the doctor would then inform the MHRA of this side effect, but it’s frankly unlikely given the low low reporting rates of adverse drug reactions by doctors

www.bant.org.uk/bant/jsp/index.faces

- she recommended it in one Guardian column as a way to find a nutritional practioner in your area.

..anyone know anything about this lot?

The BANT website looks quite official, with links to “Training” and stuff about “qualified nutritional practioners” and even a Complaints Procedure, so they seem to be trying to look official and self-regulating / respectable. The list of “Training Institutions” is all small natural health colleges, plus the Westminster University School of Integrated Health.

I know David Colquhoun on his website at

www.ucl.ac.uk/Pharmacology/dc-bits/quack.html

gets particularly exercised about Universities setting up “Alt Health” degrees. Can’t remember if he’s had a go at Westminster

Without labouring the point (oh well, I’ll just go ahead and labour it, why not….) the Alt Health people get to have their cake and eat it. If your doctor misdiagnoses you, or gives you the wrong treatment, you can sue him/her, and s/he can get struck off and lose their livelihood.

If you go to an Alt Health practitioner with a condition that is eminently treatable by conventional medicine, they are mostly under no professional obligation whatsoever to tell you so (unregulated, again). Instead they can charge you whatever you are prepared to pay for Bach Flower Remedies, Primal Scream therapy, Homeopathic tinctures, Laying On Of Hands etc.

You might describe this as “odd”.

Plus ca change….

The “What really works” tag had me laughing. I read one of her columns at random and found it touting Lemon Balm as a therapy for “low mood or melancholia”. This was a response to someone who had taken Prozac but wanted a herbal remedy.

According to La Clark lemon balm “performed well in double-blind, placebo-controlled University research trials”. This looked suitably impressive and caught my eye so I had a look on medline. There ARE two or three small trials, all done at one unit in Newcastle. But they actually say nothing about low mood/melancholia, instead indicating that the stuff might help with mild anxiety, or help you concentrate. Not quite the same thing as treating depression.

I really can’t believe what some of these people get away with. Can they sleep at night? Probably after a strong draught of Lemon Balm, KavaKava and Valerian.

This is actually a mild example of Alt-Healthery, since at least it is based on something vaguely scientific, however minimal.

It all just testifies to the credulousness of the public, fed by the voluminous mystification (can I say that?) of all the Alt Health columnists and pundits. The public seem to want desperately to believe in magic bullets for curing disease or keeping you healthy, only they want to have “natural” ones instead of “Drugs”. A fascinating (if depressing) phenomenon.

Diet is another good example of Alt Health mystification. One of my more trenchant medical buddies has taken to joking that he is going to write a dietary advice book (a la Poo Lady) containing the evidence-based info about diet and health, and retire on the proceeds. The trouble is that apart from the old nostrums (“Eat lots of fresh produce” “At least five portions of fruit and veg a day” “Avoid processed foods” “Try and cook with unsaturated fats” “don’t eat too much red meat”) there isn’t much to say. But of course if people really hoisted in that the sensible advice on diet

(i) is already dispensed by mainstream healthcare people; and
(ii) could probably go on one side of A4 paper

then the whole Alt Health industry would risk going down the pan.

www.google.co.uk/search?num=100&hs=RQn&hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&q=+site%3Awww.timesonline.co.uk+%22victoria+health%22+susan&btnG=Search&meta=

Can’t imagine that there would be a conflict of interests between her work in the Sunday Times and flogging tat through Victoria Health, but there you go.