Herbal trade tries to self-regulate sans guidelines or punishments
Ginsengs, echinaceas, and ephedras, oh my! These herbs sound innocuous enough, however, according to Memory Elvin-Lewis, Ph.D., professor of microbiology and ethnobotany in biomedicine in Arts & Sciences at Washington University in St. Louis, Americans are unaware of the dangers inherent in these herbal supplements. Not only are we self-prescribing herbal supplements at alarming rates, but we are not reporting these medications to our physicians. Additionally, herbs are not effectively regulated by the Food and Drug
Administration (FDA), so there are multiple issues including adulterations, pharmaceutical additions, pesticides, and pathogenic microorganisms that might alter the safety and efficacy of the herbs that we pick up at our local organic grocery store.
According to Elvin-Lewis, the American population believes that it is sufficiently educated, whether through formal education or Internet resources, to self-prescribe herbal remedies and supplements. We believe that reading labels tells us the whole story because in many cases, it does. But with herbal remedies, Americans believe what they hear, see on television, and read–and this could be incredibly dangerous.
"Those we trust the most to help us are hamstrung," says Elvin-Lewis. "We talk about the weapons of mass destruction in Iraq, but that could very well be the herbal remedies here in the United States."
She details many of the incredibly alarming issues in contaminants and adulterations that currently occur in herbal remedies in her chapter "Safety Issues Associated with Herbal Ingredients," in Advances in Food and Nutrition Research, Vol. 50 (2005).
In fact, there have been documented cases of clinical poisoning in North America from herbal or ethnic remedies that included mercury or lead. Additionally, it is possible to find unlabelled pharmaceuticals co-mingling with herbal remedies. The FDA issued warnings in 2003 and 2004 against some herbal sexual enhancement products that contained unreported but significant levels of prescription drugs such as Cialis and Viagra. Individuals with cardiovascular disease, for example, could experience serious side effects from an herb that included these undocumented pharmaceuticals.
Furthermore, there are concerns about the sterility of herbal remedies in the States. Elvin-Lewis goes on to say that, "It is the nature of herbal products not to be sterile, and if storage is improper or prolonged, certain organisms may multiply or elicit toxins to dangerous levels."
Confusion and adulteration
According to Elvin-Lewis, it has become increasingly apparent that those collecting some of the herbs are confusing one similar species – Chinese star anise for Japanese star anise, for instance – for another and thus producing herbal combinations that have the potential to have incredibly serious side effects.
Even timelier for Americans in the wake of hurricane Katrina is the fact that in the face of natural disasters, this adulteration of herbs with other plant contaminants becomes more common due to a decreased supply of the original herb.
"We must understand safety in herbal remedies on a global scale," Elvin-Lewis warns, due to the fact that imported herbal remedies are increasingly available at the local grocery store and other easily accessible locations across the nation. If you must purchase herbal supplements and remedies without the advice of a knowledgeable medical professional or herbalist, Elvin-Lewis suggests that you look for the herbal remedies imported from Canada, as they are stringently regulated through a law passed in 2004 entitled the Natural Health Products Regulations that ensures that the over-the-counter substances are appropriately manufactured, packaged, labeled, imported, and distributed according to the category of natural medicine to which they belong.
"We are in danger of going over a cliff, so to speak. We must accept regulatory control of herbal remedies in order to protect our citizens," says Elvin-Lewis. She likens the ineffective herbal regulation situation to that of seatbelts–creating laws and enforcing those laws for the good of each citizen has saved innumerable lives, and she hopes that in the future, laws and regulations regarding herbal remedies and supplements will be in place to save lives. Currently, the herbal remedy trade attempts to self-regulate. But the trade has no power to enforce stringent guidelines or punishments upon dealers who are not following safety requirements or are peddling products that are not exactly what they claim to contain. Additionally, what is written on labels of herbal remedies in the United States has not yet been standardized, so often unsubstantiated claims of efficacy can be present with impunity.
Americans under-report herbal uses to their physicians, Elvin-Lewis says, thus producing interactions with prescription drugs and herbal remedies that can turn humans into walking time bombs. Additionally, not all medical schools educate physicians about the incredible dangers or potential drug cross-reactivity of herbal remedies, so this knowledge is left up to the physician to self-educate.
If physicians do spend the time to properly learn the latest information about current herbal remedies, they can be a great resource for the general patient. However, the field is crippled by not having a large-scale resource bank of information to which doctors can turn for reference about specific herbal remedies and supplements.
Telling the doctor
"Telling one’s physician is only half the story because the majority of medical practitioners do not understand either the benefits or dangers associated with herbal use. " Elvin-Lewis says. " It should be emphasized that they must learn to ask questions about herbal use and dietary supplements, without judgment, and be able to determine how uses might be affecting the well being of the patient, or how these might be interacting with pharmaceuticals that are being prescribed. Ideally this information might eventually be inserted into a data base which would provide the answers needed.
"I would urge that medical schools sponsor continuing education programs on the subject, like some already do, to keep both their faculty, students and alumni suitably informed on a regular basis. "
The large majority of individuals in the United States easily can think of a time in which they either took an herbal remedy/supplement or know someone who has taken one – remember St. John’s Wort, echinacea, ephedra, even chamomile?
Dr. Elvin Lewis states, "Being aware of the possible side effects and cross-reactivities of each supplement is of paramount importance, but it is only the first step in creating a safe and effective herbal trade in the United States."
Source: Washington University in St. Louis. May 2006.