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Herbal medicines – toxic side effects and drug interactions

TESTING ALTERNATIVE THERAPIES - La Trobe University’s decision to accept funding from Swisse for a new centre to research alternative medicines has sparked controversy. This series looks at how the evidence…

Most people don’t think of herbal medicines as drugs so they don’t tell their doctor about taking them. Ryan Somma/Flickr

TESTING ALTERNATIVE THERAPIES - La Trobe University’s decision to accept funding from Swisse for a new centre to research alternative medicines has sparked controversy. This series looks at how the evidence behind alternative medicines can be assessed, and the ethics of such links between industry and research institutions.


The simple fact that herbal medicines are drugs is underappreciated or not understood at all by most people. They include good drugs, bad drugs and completely useless drugs, but they are drugs nonetheless, and therein lies a lot of grief.

Herbal medicines are often promoted as “natural” (and therefore gentle). People tend to think of a relaxing cup of chamomile tea made from ingredients hand-picked by benevolent beaming grannies in an Arcadian setting. But while the implication is that “natural” is good, the majority of the most toxic compounds we know of are natural.

Natural toxins

Botulinum toxin is 100% natural and the most deadly substance known on this planet. Yet suitably diluted Botulinum toxin is used to relieve intractable muscle spasms (as well as make the skin less wrinkly by paralysing muscles with Botox).

While the vast majority of herbal medicines are not as dramatically lethal as Botulinum toxin, virtually all will have some adverse effects. Indeed, any substance that alters your body’s physiology will have side effects.

After all, the main reason that there so many chemicals in plants that we can use as medicines is that they are used as defences. So they interfere with some aspect of physiology to stop animals eating them (morphine, caffeine, Tetra-Hydro Cannibidiol in marijuana and those lovely aromatic oils in Eucalyptus oil are some well-known examples). Or they provide defence against infection (salicylic acid in willow bark, for instance).

So you would expect some side effects.

Extract of foxglove is effective for treating heart failure, but get the concentration wrong and it is lethal; willow bark is effective for reducing pains and fever but causes ulceration of the mouth and throat if used for a while; and Senna pods are used to relieve constipation, but can cause heart problems and gastrointestinal damage.

Drug interactions

What’s more concerning is that since people don’t think of herbal medicines as drugs, they also don’t consider they will interact with their other medicines. But they do.

St John’s Wort enhances the effects of any prescribed antidepressants, leading to potentially lethal overdose. John Tann/Flickr, CC BY

The poster child for drug-herb interactions is St. John’s Wort – because it has a twofold effect. The compounds in it that are responsible for its antidepressant effect will enhance the effects of any prescribed antidepressants, leading to potentially lethal overdose.

Not only does St. John’s Wort interact with antidepressants, the chemicals in it also stimulate the liver to break down certain classes of drugs more rapidly. People taking the herb have been endangered because their anti-rejection drugs or anti-HIV drugs have been broken down below effective therapeutic levels.

Despite the side effects of St. John’s Wort being well known in the pharmaceutical community, information about them from points of sale are generally very poor and most consumers will be unaware of them (see also here).

And it’s not just St. John’s Wort. A whole range of herbal medicines interact with conventional medicines (dandelion and diuretics is another example). This puts people in harms way when they are prescribed conventional drugs.

Because most people don’t think herbal medicines are drugs, they tend not to tell their medical practitioner about their herbal use. And medical practitioners tend not to ask about specifically about it as they expect their patients will tell them!

Missing ingredient

But if herbal medicines have such a range of adverse effects, why don’t we see more evidence of them? There are three reasons for this.

First, although figures for complementary medicine show roughly half of Australians taking complementary medicines, these are mostly vitamins (which have their own problems). Far fewer people actually take herbal medicines.

In a study of antidepressant use in New South Wales, for instance, very few people were taking St. John’s Wort, and even fewer were taking it together with conventional antidepressants.

Second, adverse reactions to herbal medicines are significantly under reported. While there is a “blue card” system for reporting adverse events to conventional medicines, herbal medicines are often bought from health-food stores, or prescribed by herbalists who don’t participate in the system.

So there’s no way for most herbal medicine buyers to report adverse events.

Extract of foxglove is effective for treating heart failure, but get the concentration wrong and it is lethal. e_chaya/Flickr, CC BY

Finally, there’s some evidence that many herbal medicines have very low amounts of the active ingredients, or do not have the active ingredient at all. So many herbal medicines are no more than expensive placebos.

Learn to distrust

Most herbal medicines are classified as “Listed” by the Therapeutic Goods Administration. This means that unlike registered medicines such as paracetamol and statins, the evidence required for approval is much less stringent.

In fact, it’s basically an honour system where the herbal medicines sponsor says there’s no evidence of harm, and we hold documentation that shows this. Mostly, the evidence is historical, claiming that people have been using it for generations without evidence of harm.

But a long history of use is not necessarily evidence of no harm. Willow bark, for instance, has as long a history of causing ulcers as it has of relieving pain, but its serious side effects have not passed into lore.

Until we used modern medical investigation, we were unaware of the harms caused by the herb borage, and the severe kidney toxicity and cancer caused by the Aristolochic acid found in herbs used in traditional medicine.

Herbal medicines are widely trusted but that trust is mostly due to our imagination coupling them with a bucolic vision of nature which never existed. It’s time to end this misplaced trust and start seeking evidence.

We still only have a very poor idea of the potential harms posed by the panoply of herbal medicines on sale.

This is the second article in our series about complementary and alternative therapies. Click on the links below to read the others:

Can we scientifically test herbal medicines?

Join the conversation

168 Comments sorted by

  1. Belinda Robertson

    Naturopathic Herbalist

    It is common knowledge that herbalists don't use foxglove. It is deadly. The pharmaceutical industry use it widely. I have been a practicing herbalist for 18 years and the amount of patients I see who are sick due to the adverse side affects of medicines they have been given by their doctors is growing. When I ask if their adverse reaction was recorded the answer is often that the doctor didn't see a link. Surely if there may be a link these reactions should be recorded so they can be accessed…

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    1. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Belinda Robertson

      Foxglove extracts were replaced with pure digitalis, which can be administered in carefully controlled doses, conventional medicine uses aspirin, rather than willowbark, as it has a better side effect profile and when you get 100 mg of aspirin, you are getting 100 mg of aspirin, rather than an unknown amount of sialacin in any given willowbark preparation.

      Have you reported these adverse reactions? Thee does have to be a plausible connection between taking the medicine and seeing the reaction (or it may be an interaction of a herbal medicine with the conventional medicine)

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    2. Paul Rogers

      Manager

      In reply to Belinda Robertson

      Belinda, a genuine question: how do you guarantee the quality and even the authenticity of the materials you prescribe?

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Ian Musgrave

      Isn't this the very basis of early pharmaceutical development.

      When a chemical of botanical source is found to be efficacious, there is a real advantage to separating out that compound, purifying it, and producing verified, standardised doses.

      I expect the ancient monks that practised these imprecise arts would have been overjoyed to have the technology we do now, to make these remedies much safer and more reproducible in effect.

      So ironic that we would be discussing the need to keep pharmacology in the dark ages while using the latest communication devices, isn't it.

      Herbal medicine is just unsophisticated pharmacology

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  2. John Crest

    logged in via email @live.com.au

    "...completely useless drugs, but they are drugs nonetheless".

    If it's useless, what makes it a drug (aside from the fact someone wishes to refer to it as such)?

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Michael Shand

      Caffeine is a good example of a botanically-derived chemical which has an effect on human physiology.

      In pre-technical culture, it was only available from the plant source, and the active principle had not been isolated.

      So, hot water or steam extraction of roasted beans of the coffee bush would be the ''herbal medicine'' (that makes you feel more awake and energetic), and caffeine would be the ''drug''.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Michael Shand

      Same for tobacco, Michael.

      Inhaling the smoke of burning, dried tobacco leaves would be the herbal medicine that helps settle anxiety, the addictive chemical substance is nicotine, and the tar produced from combustion contributes to carcinogenesis.

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    3. Belinda Robertson

      Naturopathic Herbalist

      In reply to Sue Ieraci

      and it wasn't long ago that doctors prescribed tobacco for anxiety....so poorly they understood herbal medicine

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Belinda Robertson

      Ms Robertson repeats the old trope '' it wasn't long ago that doctors prescribed tobacco for anxiety''. Sigh.

      Tobacco is an effective anxiolytic. It was science in medicine that discovered that chronic tobacco smoking was associated with both lung and vascular complications, and the medical profession not only stopped recommending tobacco but joined the campaign to reduce tobacco smoking (remaining at the forefront today).

      Benzodiazepines are also effective anxiolytics. When medicine showed…

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    5. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Sue Ieraci

      Sue yes good answer to an old one however it is most likely the nicotine in the tobacco, not just the tobacco and this supports your argument for active constituents. However, I think what Belinda was saying is that there are many conditions that can be managed using the whole herb and not just one active ingredient of the herb. In some cases the phytochemical action is multi-tasked as it is with St John’s wort that is the data are consistent with the therapeutic effects, safety profile and side-effects…

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Russell Setright

      ''Setright'' - what would stop us from isolating any or all active ingredients in a plant material with various active compounds? It would be easy to isolate them and test them in any combination.

      Your example misunderstands the context of use of these drugs you have listed. That paper is about the effectiveness of drugs in CARDIAC ARREST. Because it is such an extreme situation (the most extreme - ie the process of dying), all efforts have been made to improve the (currently dismal) outcome.

      But here's the thing: all these drugs have been tested in cardiac arrest, and found not to improve the outcome, so they are no longer recommended. That's how medicine works.

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    7. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Sue Ieraci

      With St John's wort efforts to replicate the clinical effects of the whole herb have been undertaken however, to date these have not been successful.
      Lets get behind medications that work whether or not they are a single chemical or a herbal complex. There is only one type of medicine and that is good medicine.

      Monograph St John's Wort
      Level A - Strong scientific evidence for this use
      Depression (mild-to-moderate)
      Human research suggests that St. John's wort is more effective than placebo…

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    8. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Belinda Robertson

      A case in point, based on traditional herbal use, no one expected tobacco smoking to cause cancer and Herat disease, it was modern medical science that uncovered these effects. despite tobacco smoke being a potent carcinogen, herbalists didn't know this.

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    9. Miles Ruhl

      Thinker

      In reply to Sue Ieraci

      "Thankfully the progression of medicine and pharmaceutical science has led to safer and more effective management of anxiety than cigarettes and alcohol."

      Very true Sue, but I imagine I'd get far more enjoyment from a whisky and a fag than I do from my Pristiq!

      And the withdrawal from the Pristiq is almost as unpleasant as from nicotine! (Heavy smoker, non drinker).

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    10. Edward John Fearn

      Hypnotherapist and Naturopath

      In reply to Ian Musgrave

      Indeed a number of early Herbalists and even Naturopaths were smokers.

      According to the herbalist Nicholas Culpepper (18 October 1616 – 10 January 1654), who was himself a heavy user of tobacco “A constant chewing, or smoking of tobacco, hurts the appetite by depriving the constitution of too much saliva.” He believed it was improper for lean, dry hectic people, but possibly useful for the more gross or those suffering from cold conditions. Its use as snuff he felt was seldom associated with…

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  3. Paul Rogers

    Manager

    Good article, Ian. This needed to be said.

    The story of aristolochic acid should be enough to frighten people off random consumption of herbal medicines.

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  4. Heather Haines

    logged in via Facebook

    Interesting article and thank you.
    I assume it is a typo above ("relive constipation") - but it made me laugh

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    1. Reema Rattan

      Health + Medicine Editor at The Conversation

      In reply to Heather Haines

      And it made me blush! Nicely spotted, it's fixed now.

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  5. Peter Campbell

    Scientist (researcherid B-7232-2008)

    People are remarkably good at holding contradictory beliefs while apparently experiencing no discomfort.
    On one hand they will swear by the effectiveness of some herbal treatment (thereby assuming a real pharmacological effect of a real chemical contained in the herb). On the other hand they assume harmlessness because, being natural, it must be benign, and by implication does not really have any active chemicals in it: 'It is really a drug but it is not really a drug.' or 'I believe it is harmless because it is only a placebo, but I also believe that it has something in it because if I believed otherwise the placebo would stop working!'
    Those profiting by the sale of these drugs, which may in some cases be effective treatments, encourage this sort of woolly thinking.

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  6. Brian Keyte

    Potter

    Thanks Ian. You are preaching to the converted here. I will start using herbal medicines when they print the actual chemical formula on the packaging. As plants grow in different soils under different conditions and are harvested at different times in different ways, so the chemical composition varies enormously. Then storage and processing change things again, some for the better some for the worse. The active ingredient and any potential side effect ameliorating/enhancing tramp materials could be present in any amount at all. When product samples are tested by a certified laboratory and an MSDS is included along with an extensive list of contra indications and potential interactions then I'll reconsider.

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    1. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Brian Keyte

      A case in point is St. John's Wort. The amount of hyperforin varies enormously during the season, and between different cultivars, so batches of St. John's Wort can vary enormously in their effectiveness and potential side effects. Some St. John's Wort preparations are normalised to the hyperforin content, but how often the batches are tested can make a big difference.

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    2. Paul Rogers

      Manager

      In reply to Brian Keyte

      Yes, Brian, and even then I'd be sceptical. I wouldn't want some random, toxic plant alkaloid getting into the mix in error.

      Aconite, hemlock, strychnine, aristolochic acid anyone?

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    3. Belinda Robertson

      Naturopathic Herbalist

      In reply to Brian Keyte

      The day they print the formula on the herbal medicines is the day herbal medicine becomes allopathic medicine. Humans do not come with a chemical formula to their make up. There is not a neat one formula fits all which is why so many people are turning away from allopathic medicine.

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Belinda Robertson

      There is no such thing as ''allopathic'' medicine - it is a term invented by DD Palmer, the originator of the ''subluxation'' and ''nerve interference'' model that became classical chiropractic.

      Also, people are definitely NOT turning away from medicine - they are using it more than ever, but paying for non-science-based remedies as well.

      Any remedy that is prescribed and marketed should be transparent in its ingredients, and certified as containing what it says on the label - individualised or not.

      Actually, though, people DO come with a chemical formula. IF we don't have a pH of 7.35 to 7.45, a serum sodium concentration of 135 - 145 mmol per litre and a serum potassium level of 3.5 to 5 mmol/litre, we feel bad.

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Sue Ieraci

      Apologies - my mistake - ''allopathic'' is not from DD Palmer but from Samuel Hahnemann - originator of ''homeopathy''.

      (Palmer coined ''dis-ease'')

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    6. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Sue Ieraci

      Yes Sue I agree there should be NO "secret" formula. Gee if only our chemical makeup was as easy to understand as our blood electrolyte profile.

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    7. Sue Ieraci

      Public hospital clinician

      In reply to Russell Setright

      Which aspects of chemical make-up do you mean, ''Setright".

      I only used one example, but we also know the chemical make-up of bone, collagen, skeletal muscle, heart muscle, brain, cerebrospinal fluid, lymph, gastric juice, bile....which bits remain ''secret''?

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    8. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Sue Ieraci

      Sue, I was talking about some herbal formula not having all relevant information on the label being "secret" not secret chemical make-up.

      There are no secrets in chemical/biochemical makeup only a difficulty in fully understanding some aspects of this makeup, human genome, biochemistry and metabolic pathways. And in particular the actions of some nutrients/herbs on the p53 gene, as it seems nearly impossible for a healthy cell to become cancerous unless it inactivates the p53 gene network somehow and I am interested in understanding what are the microenvironmental conditions that favor the selection of cells with p53 mutations?

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    9. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Ian Musgrave

      Very true Ian and it is desirable to have St John's Wort preparations standardized. Standardization if possible helps ensure efficacy and safety of all therapeutic substances.

      Under the good manufacturing practice code(GMP), as required by the TGA, is the same for all medications herbal or pharmaceutical. The TGA requires a standard testing procedure for batches and samples of batches are keep for analysis if required. If any product is sold and it doesn't comply with its listing or registration…

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    10. Miles Ruhl

      Thinker

      In reply to Sue Ieraci

      Can one coin a term by merely adding a hyphen to an existing word, merely altering their own personal meaning?. And I would suggest the term 'allopathic' has become colloquially accepted as meaning how it is used above; 'traditional' medicines.

      (P.S. It is purely coincidental that it has anything to do with DD Palmer, I just enjoy the nuances of the English language, promise!)

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    11. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Miles Ruhl

      If fact Allopathic referes to the medicine of Galen, where "opposites" were used. A "hot" disease such as a fever was treated with a "cold" medicine. Modern medicine ditched this long ago, and treats diseases based on mechanism (eg antibiotics for bacterial infection, insulin for type I diabetes and so on)

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    12. Laurie Willberg

      Journalist

      In reply to Ian Musgrave

      The term "allopathy" was coined by Dr. Samuel Hahnemann, "allos" meaning opposite, and "pathos" meaning suffering, and used to describe the conventional medical treatments of his day that included the administration of toxic drugs, bloodletting, purging and the cutting off of various bodyparts.
      Many mainstream medical associations today refer to their own medical scope of practise as allopathic, in contrast to "homoios" which means like (and "pathos" suffering) = Homeopathy.
      Kindly refrain from rewriting history.

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    13. Yosefine Deans

      Chiropractor

      In reply to Laurie Willberg

      Interesting information on the origins of "allopathic" terminology. I simply meant it to say that it works against the pathology. A similar argument can come from organic agriculture versus the form that kills pests, weeds etc. I believe that medicine used to consist of blood letting, purging, amputation etc. Horrible stuff. Apparently that is why Chiropractic became so popular - at a time when the alternative was no so bright. But these were the origins of modern medicine, true? I think in a day to come the medicines prescribed these days will be seen as crude too.

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    14. Laurie Willberg

      Journalist

      In reply to Yosefine Deans

      Yes. And as far as Chiropractic goes, the 1980's Wilkes case in the U.S. showed that the American Medical Association went out of its way to actively put down Chiropractic to insurers, etc. so that it could continue to plug pain drugs and back surgery as the "only" options available to patients.
      I still don't see family doctors making sure that their patients understand that these pain drugs are highly addictive and cause organ damage, or surgeons admitting to the high percentage of failed back surgeries.

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    15. Miles Ruhl

      Thinker

      In reply to Laurie Willberg

      Shhh Laurie, someone may hear you.

      That sort of talk in these circles is met with a stern talking-to and a prescription for anti-psychotics.

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    16. Miles Ruhl

      Thinker

      In reply to Paul Rogers

      I bust a mean 'Hardstep' so reckon I could manage the 'Thorazine Shuffle', though the interactions it may have with the West Angolan Connifer-based 'Erectus Maximus All-Nightus' might be catastrophic.

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  7. Jack Ruffin
    Jack Ruffin is a Friend of The Conversation.

    logged in via email @hotmail.com

    Knowing the properties and potential effects of any medicine or remedy helps us to assess their uses. Good research combined with communication of the results to the public has served us well. We gradually sort out the wheat from the chalf and thus our standards of health have improved. This article is part of that necessary communication. Thanks Ian for putting it together.

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  8. Robin Bell

    Research Academic Public Health, at University of Newcastle

    Well said Ian.
    Its time to stop this silly parallel medicines regulatory system and provide the same protection for public safety for all medicines, herbal or manufactured. Alternative or complimentary medicines should be required to pass the same rigorous process as prescribed medicines, and provide similar public information documentation. That way consumers can be sure of what it is they are buying and using.

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  9. Richard Henfrey

    Manager

    One correction: I think you have confused the requirements for safety and efficacy data in the Australian listing system. It is absolutely not true to say that the evaluation of safety data is an "honour system" - for a herbal ingredient to be listable, it goes through a rigorous safety assessment conducted by the TGA. This process absolutely recognises potential differences caused by different extraction techniques, plant parts and harvest conditions etc. The resulting approved ingredient is standardised to a USP or BP monograph if available, or a TGA compositional guideline if not.

    It is true to say that there is no pre-market evaluation of efficacy data. However, the certification made by sponsors when they list their product is binding, and it is effectively enforced through a process of post market monitoring.

    There are issues with the listing system for complementary medicines in Australia, but consumer safety is absolutly not one of them!

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    1. Michael Bunce

      ARC future fellow researching in the fields of ancient DNA and wildlife forensics at Curtin University

      In reply to Richard Henfrey

      Hi Richard - I have to disagree with many of your comments. As Ian points out in his link 90% non-compliance of TGA regulations is hardly a ringing endorsement of the efficacy of the regulatory framework in Australia.

      You state that; "There are issues with the listing system for complementary medicines in Australia, but consumer safety is absolutly not one of them!" - how do you define consumer safety? - how do you know there is not substitution and/or adulteration of medicines that are having adverse health outcomes? Maybe you can outline what the "through" post-market monitoring is? - one of the finding of the audit that Ian listed was that there needs to be better post-market auditing.

      The complementary video clip on ABC's "the checkout" might be worth viewing (it is at the bottom of the page); http://www.abc.net.au/tv/thecheckout/clips/#

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  10. Michael Shand

    Software Tester

    Great Article, I am always bemused by the use of the word Natural...unless it's supernatural then of course it's natural, cot death is as natural as oregano is natural

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    1. Sean Manning

      Physicist

      In reply to Michael Shand

      Agreed. I can't actually think of anything this is Unnatural. Is a Beavers dam natural, of course it is. Then why isn't a sky scraper natural?

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Michael Shand

      If there is ''supernatural'', is there also ''sub-natural''?

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  11. Yvonne Altclass

    Naturopath/Herbalist

    I beseech you, in the bowels of Christ, think it possible you may be mistaken.

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    1. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Yvonne Altclass

      Yes, it is entirely possible that herbal medicines are less useful and more harmful than I currently think, based on epidemiological and clinical trial evidence..

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  12. Andrew Watkins

    Neonatologist

    The last quote from Cromwell, something of a religious fanatic, nicely underlines the often theological character of such debates.

    It is also a sobering thought that medicines ( homeopathic, naturopathic and allopathic ) have killed more people than Cromwell ever did ( and he had a pretty good score, just ask the Irish )

    Some rigour is needed in both regulation and thought around this - the only medicine without side-effects is one without effects. Surely "natural " remedies should be subject to the same regulation as conventional allopathic medicine?

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  13. Jennifer McLennan

    Artist

    As a consumer, I believe health and safety are important for society and the individual, however when picking our battles let’s use common sense and put things into perspective.

    According to New Zealand based risk analyst Ron Law’s 2007 graph comparing the risk of taking complementary medicines the figures show:
    - A patient in hospital is 243,000 times more likely to die from a preventable medical injury during their stay in hospital than from using complementary medicines for a year.
    - The…

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    1. Joe Gartner

      Eating Cake

      In reply to Jennifer McLennan

      jennifer,
      i hope that you realise that none of these statistics add up to anything. Clinical errors notwithstanding, I think it is entirely expected that people in a hospital are more at risk of dying than people not in a hospital; because hospital is full of sick people.

      Sick people taking medicines are more likely to die than sick people taking supplements because sick people taking medicines probably have more severe disease. let's use heart disease as an example. is it a surprise that a patient with ischaemic heart disease could die at any moment despite taking therapy that may prolong quality and quantity of life.

      i think the peddlers of herbal supplements are in the luxurious position of not having to supply anything that has an effect. A luxury not afforded to our clinicians.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Jennifer McLennan

      Ms McLennan - your post neglects the other side of the risk-benefit equation: the benefit.

      I don't have the exact figures at hand, but I suspect that the number of sick people helped by science-based medicine would be millions of times greater than those helped by OTC supplements or homeopathy.

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    3. Belinda Robertson

      Naturopathic Herbalist

      In reply to Jennifer McLennan

      Jennifer, nice to see some figures to highlight the facts. The attack on herbal medicine comes from a lack of understanding of the practice of herbal medicine and a fear of the unknown. Statistics don't lie.

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    4. Andrew Watkins

      Neonatologist

      In reply to Belinda Robertson

      Statistics mightn't lie, but crap statistics do - remember Churchill's quote about statistics being used as a drunk uses a lamppost, more for support than illumination.

      As Sue and others have explained, statistics are only valid if comparing like with like, free of ascertainment and other biases and one has a clear idea of the denominator and of who / what may have been excluded from the figures, to say nothing of a number of other caveats.

      Raw numbers say nothing.

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  14. Elizabeth d'Avigdor

    Naturopath

    It’s a shame that in his reasoned attempt to make a cogent argument Mr. Musgrave finds it necessary to take a cheap shot at herbalists by likening them to some Arcadian vision of little old ladies beaming benevolently over their chamomile. Whilst we do indeed have a lot to learn from those wise people, our understanding of the pharmacology of herbs, their benefits (and, indeed, the potential for harm) has come a long way.
    No trained herbal practitioner would argue that herbs are medications – from…

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    1. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Elizabeth d'Avigdor

      "No trained herbal practitioner would argue that herbs are medications"

      are you sure you didn't mean ""No trained herbal practitioner would not argue that herbs are medications" otherwise this statement is completely wrong.

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    2. Elizabeth d'Avigdor

      Naturopath

      In reply to Ian Musgrave

      No actually Ian, the sentence is grammatically correct. Think of it as "no-one would argue (the point that) herbs are medications". Otherwise you have a double negative and that just would not do, would it? What a calumny it would be to be grammatically incorrect in a debate though - hopefully it would not dilute the message!

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Elizabeth d'Avigdor

      Ms D'Avigdor - medical professionals are accustomed to collaborating with a range of colleagues like dietitians, pharmacists, physiotherapists and occupational therapists.

      It is difficult to see any additional benefit from collaborating with a practitioner of proto-pharmacology when we have experts in pharmacology.

      Modern pharmacology not only benefits from plant-derived therapeutic substances, but also defines the modes of action and the physiological and pathological processes that are involved in both disease/injury and healing.

      I find it hard to understand why a plant-derived therapeutic substance would be preferred in impure, variable-dose form, as opposed to purified, standardised dose.

      Can you explain to me what a herbalist can add to our understanding of pharmacology, and any evidence that impure plant materials are better therapies than the purified active substances?

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    4. Elizabeth d'Avigdor

      Naturopath

      In reply to Sue Ieraci

      Not being a protopharmacologist I cannot respond to your point about that.
      I agree with Ms Macfarlane - balance is a key word in this debate. We are getting quite a tennis match of reference serves - great learning experience - but I think it is pointless to try and defend a viewpoint against those who are simply ideologically opposed to, and, I have to say, not very well educated in herbal medicine practice. Academic work has taught me well to recognise flaws in 'evidence', and knowing this I am dumbfounded that we associate such certainty with scientific argument. I think we should be very careful of the arrogance associated with unfounded certainty and not throw out a healthy baby with the bathwater. I'd love to be so certain, I do have a lot to learn. Fortunately clinical practice continues to teach me much as well as keeping up to date with the evidence.

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Elizabeth d'Avigdor

      Thanks for your response, Ms d'Avigdor, but would you mind responding to the (genuine) question I asked before?

      ''Can you explain to me what a herbalist can add to our understanding of pharmacology, and any evidence that impure plant materials are better therapies than the purified active substances?''

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  15. Russell Hamilton

    Librarian

    Haven't I read the same (storm in a tea cup) article, by the same author before? Several times?

    Maybe time to move on to something new ... the article in the current MJA about pyrrolizidine alkaloids is something new to worry about. Honey on breakfast cereal doesn't look so innocent anymore.

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    1. Paul Rogers

      Manager

      In reply to Russell Hamilton

      An oldie but a goodie. Years ago, comfrey tea was very popular. If you want a good dose of those alkaloids, try that. I hope herbalists are not prescribing comfrey these days. Even topical use may be questionable.

      I would be interested in the doses he is talking about. Here is the abstract:

      "Pyrrolizidine alkaloids (PAs)have been detected worldwide as contaminants in milk, eggs, meat and honey at levels that are too low to cause rapid liver failure or HSOS but perhaps sufficient to initiate chronic diseases, including a range of cancers and pulmonary arterial hypertension (PAH) leading to right-sided heart failure."

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    2. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Paul Rogers

      The link is here
      https://www.mja.com.au/journal/2014/200/2/food-contaminants-capable-causing-cancer-pulmonary-hypertension-and-cirrhosis

      This quote is appropriate for the current conversation "a German Federal Pharmaceutical Ordinance has, since 1992, banned the sale of all but a few traditional herbal medicines containing PAs that must be shown to contain no more than 1 μg of PAs per daily dose or 0.1 μg if the herbal product is taken daily for more than 6 weeks per year."

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  16. Godfree Roberts

    logged in via Facebook

    Telling us "The simple fact that herbal medicines are drugs" is elision at best, and deliberately misleading at worst. Herbs are plants, with whom we've co-evolved for as long as evolution has been going on. Each contains thousands of complementary 'active ingredients', many acting as buffers, catalysts, and cofactors.

    The "drugs" you refer to are mostly dangerous (to some) overly-concentrated, synthetic attempts to mimic the gentler, better adapted affects of herbs.

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    1. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Godfree Roberts

      Herbs are plants that have evolved highly toxic defences to stop predation and infection, we can use some of these toxins, suitably diluted for treatment of disease (or straight out, as we mass so much more than the insects or small herbivores that are the intended targets).

      All the examples I give are of the actual herbal medicines. St. John's Wort will cause death or serious side effects in its plant form (if you harvest it at the time when there is actually some hyperforin in it).

      We haven't co-evolved with these plant toxins, we have only very recently started to use them (although marijuana is probably the oldest medication, with evidence of use at around 50,000 years ago, that is still not enough time to co-evolve)

      If you think plant medicines are gentler, try chewing on some Senna pods.

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  17. Laura Macfarlane

    journalist

    There is a wealth of scientific evidence that exists and continues to grow, supporting the efficacy of many vitamins, herbal medicines and other complementary medicines (CM) but the “witch hunt” against CM and the assertion that most are nothing more than placebos continues.

    The lack of balance that exists in much of the reportage on CM, such as the one above by Ian Musgrave, is staggering.

    Good and bad evidence, and indeed lack of evidence, exists across the board of scientific endeavor. Yet…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Laura Macfarlane

      Ms MacFarlane - you omitted the data on how many sick or injured patients (of what severity and complexity) are helped by medicine every year, as opposed to how many sick or injured patients (of what severity) are helped by herbs or supplements.

      ''Wellness'' care is easy - your clients are self-selected and motivated, you can work normal hours and don't have to be on-call, you never have emergencies, you don't have to account for your outcomes or report your errors, and you have the entire medical system available to pick up your mistakes.

      There are lots of imperfections in every human service, but your number comparison is meaningless. No amount of errors in medicine will add any credibility to non-science-based therapies.

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    2. Laura Macfarlane

      journalist

      In reply to Sue Ieraci

      Ms leraci,

      As it says near my name I am a journalist not a naturopath. I am also a registered nurse and have worked (mainly in neonatal intensive care) in the public hospital system for over 20 years. Do you have the data to which you refer? You have omitted to include that too.

      Number comparisons are not meaningless in this case because they clarify that the fear about herbal medicines (drugs) that the article by Ian Musgrave is attempting to engender is misplaced when seen in the context of conventional phramaceutical drug adverse effects or deaths.

      As a journalist I am calling for balance.

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    3. Laura Macfarlane

      journalist

      In reply to Laura Macfarlane

      PS: I forgot to mention that I am a fierce advocate of Australia's public health system and the hard working personnel therein and I agree that it does indeed help many sick and injured patients every year. I for one would like to see it funded adequately enough to continue to do so. But that is not what the present "conversation" is about.

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    4. Michael Bunce

      ARC future fellow researching in the fields of ancient DNA and wildlife forensics at Curtin University

      In reply to Laura Macfarlane

      Hi Laura, the concept of 'balance' is an interesting one and is very subjective. Every conventional medicine taken has a long list of possible side-effects and a lot of underpinning data. In contrast Herbal medicines do not. In my view Ian's article is addressing this balance directly by raising possible issues with CAM's that are not widely recognised by the wider public.

      So if anything an article like this goes a long way to address the imbalance that natural=safe/good and pharmaceuticals= unnatural/harsh. I guess we have a very different idea of where the balance-point is on this subject.

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    5. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Laura Macfarlane

      It's not fear, it is countering the naive but widely held notions that herbal medicines are a) not drugs b) are safe with few or no side effects and c) they will not interferer with conventional medications.

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    6. Laura Macfarlane

      journalist

      In reply to Sue Ieraci

      PS: I forgot to mention that I am a fierce advocate of Australia's public health system and the hard working personnel therein and I agree that it does indeed help many sick and injured patients every year. I for one would like to see it funded adequately enough to continue to do so. But that is not what the present "conversation" is about.

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    7. Sue Ieraci

      Public hospital clinician

      In reply to Laura Macfarlane

      My apologies, Ms MacFarlane - when I used the pronoun ''you'', I was making a general statement (I should have used ''one'') - I did not mean to imply that you, personally, are a wellness practitioner.

      Again, you have neglected the risk:benefit ratio.

      The point about many CAM products that have potential toxicity is that this has to be seen in the context of neglible therapeutic benefit. Hence the relevance of the article.

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    8. Sue Ieraci

      Public hospital clinician

      In reply to Laura Macfarlane

      That's great, Ms Macfarlane. You work at the sharp end indeed.

      However, you also said ''There is a wealth of scientific evidence that exists and continues to grow, supporting the efficacy of many vitamins, herbal medicines and other complementary medicines (CM)''

      Could you give some examples?

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    9. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Sue Ieraci

      Hi Sue, this is a little one I put together, it has some examples re supporting the efficacy of multivitamins.
      Many people take antioxidant and multivitamin supplements to help fill the gap caused by dietary deficiencies and poor lifestyle and to help improve general health and wellbeing. It is also thought that improving diet and lifestyle may help support the immune system, improve memory, delay the onset of Alzheimer’s disease, enhance wellbeing, reduce the risk of Autistic Spectrum disorders…

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    10. Paul Rogers

      Manager

      In reply to Russell Setright

      Russell, perhaps for balance you should have mentioned the possible carcinogenic effects of beta-carotene and vitamin E (alpha) supplements in recent trials, and the pro-oxidant effects of vitamin C at high doses.

      I'm not completely sceptical of some proven uses of vitamin and mineral supplements, but this review is worth reading:

      Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force.
      http://www.ncbi.nlm.nih.gov/pubmed/24308073

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    11. Sue Ieraci

      Public hospital clinician

      In reply to Russell Setright

      OK, "Setright'' - let's go through that list.

      Your first two references are specifically about AIDS patients in developing countries. It would not be surprising if these people suffered severe malnutrition. These findings are not applicable to our population.

      No.4 is about invasive breast cancer (again not applicable to the general population) and No. 11 is a news release.

      No.s 3 and 4 are subsets of data from the US Physicians' Health Study II). IN the cancer study, they found (pasting…

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    12. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Paul Rogers

      Thank you Paul yes I should have covered these studies as well. However being the nerd that I am I alway like to read through many of the individual studies first. As you would know the b-carotene vitamin E and smokers study found that the intake of b-carotene from supplements was associated with an increase in lung cancer among heavy elderly smokers. However, not given much coverage in the same study, was that those with higher levels of vitamin E and b-carotene at baseline had a lower incidence of CA. Also those supplemented with vitamin E had less prostate and colorectal CA. Message, don't smoke and if you do don't take large amounts of b-carotene.

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  18. Yosefine Deans

    Chiropractor

    I like to look at how refined a product is. If it can be produced without taking too much from the environment then I like it. Obviously in nature there are certain things that you know not to take internally or topically or without simple processing. I like to keep health care simple so we can have simple side effects!

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  19. Russell Setright

    Author & Medical writer at Life Survival Training

    I thank for your article on herbal medicine toxicity. However, some statements in the article may need further clarification such as “While the vast majority of herbal medicines are not as dramatically lethal as Botulinum toxin, virtually all will have some adverse effects. Indeed, any substance that alters your body’s physiology will have side effects”.
    Although this may be true, this article seems to only refer to herbal medicines having these side effects when in fact all foods, herbs and medicines…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Russell Setright

      ''Taking herbal preparations made in accordance with TGA GMP and with/under the advice of their healthcare practitioner and in accordance with the directions and contraindications for use should not be discouraged.''

      Even if the claims for benefit are false or exaggerated?

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    2. Rotha Jago

      concerned citizen

      In reply to Belinda Robertson

      The author of this article is much better informed about pharmaceutical drugs than he is about herbs and those of us who consult only alternative practitioners. Unfortunately it is unlawful to provide any advices or cautions or directions for use on the labels of herbs and herbal teas. This law was passed in the 1970s, first in New South Wales and later in the rest of the country. Before then herbal and homeopathic preparations carried precise information and there were many inexpensive or free pamphlets and booklets available at the point of sale.
      There were many people and organisations dedicated to disseminating information on health at very low cost to the whole community.

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    3. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Sue Ieraci

      Sue absolutely not, any claims made should factual, approved and be based on published peer reviewed clinical trials or in the absence of these, long- term traditional use and if so stated as such. The importance of the healthcare practitioner can’t be overstated as this helps ensure proper diagnostic procedures and referrals are in place and self-diagnosis is minimised.

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    4. Mike Jubow

      Forestry nurseryman at Nunyara Wholesale , Forestry consultants, seedling suppliers.

      In reply to Russell Setright

      Setright, if that is your name and not a pseudonym, from what you have written, I presume you would be perfectly happy to have the same restrictions as conventional medicines have imposed on them? That is, for rigorous purity testing of the active ingredient, peer reviewed clinical testing and open publication of the results before applying for approval to market these drugs on the open market? And clearly marking on the label what the % is of each active ingredient? You should be able to agree with a simple set of rules like that, don't you think?

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    5. Belinda Robertson

      Naturopathic Herbalist

      In reply to Mike Jubow

      If we are forced to copy chemical medicine by reducing herbs to a list of active ingredients we are missing the point of herbal medicine. Whole plant treats the whole person. It will take a significant shift in the mindset to understand there are delicate interactions between the various ingredients within a whole plant. This is also the reason that we don't believe that just the active ingredient is important in our medicine. It is the whole plant and the whole person that is important to herbal medicine. The simplistic view of just treating symptoms of an illness is not working. Funnily enough the highly defensive and at times aggressive nature of many of the comments in this conversation only show that herbal medicines approach is gaining traction with the consumer and is beginning to erode the traditional support base of chemical medicine.

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    6. Mike Jubow

      Forestry nurseryman at Nunyara Wholesale , Forestry consultants, seedling suppliers.

      In reply to Belinda Robertson

      So, what you are saying is that it is not necessary to know what active ingredient exists in a plant? Why then even bother to make decoctions of a plant in favour of giving the whole plant to the 'patient'?

      Your statement, " Whole plant treats the whole person", leaves a lot to be desired in the credibility stakes.

      I was of the understanding that herbalists would make decoctions of, distilates of and other concentrations of herbal 'remedies' so where does this leave your 'whole plant' statement…

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    7. Belinda Robertson

      Naturopathic Herbalist

      In reply to Mike Jubow

      Most people follow and are happy to use chemical medicine. That is really fine and I don't wish to stop that happening. For those of us that are satisfied with herbal medicine all we ask is that we are able to continue this practice. We cost the medical system nothing and it simply is a matter of choice. I respect the right of people to go and visit a general practitioner and ask that you respect my clients rights to visit a herbalist if they choose to do so.

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    8. Sue Ieraci

      Public hospital clinician

      In reply to Belinda Robertson

      A very revealing post by Ms Robertson - essentially saying that herbal medicine has ''different ways of knowing''.

      But why? Every chemical in plant-derived material can be analysed and tested in whatever combination is desired. Is this too threatening to the profession?

      And what is the significance of ''we don't believe that just the active ingredient is important in our medicine''. On what basis? And if an ingredient is ''inactive'', how can it be ''important''? Doesn't that make it ''active''? All of the ingredients can be isolated and tested, individually or in combination. That's how modern pharmacy developed.

      Medicine has no reason to be ''defensive'' - it is overwhelmed with demand. Our population isn't moving away from medicine - we are using it more than ever before, but spending on (largely useless) ''remedies'' as well.

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    9. Sue Ieraci

      Public hospital clinician

      In reply to Belinda Robertson

      ''Chemical medicine''? Aren't plant materials made of chemicals?

      I respect the right of consumers to choose to spend their money on ''remedies'' if they are fully informed about their ingredients and evidence of efficacy.

      I don't recognise any right of a provider to market therapy without disclosing its content and evidence of its mode of action, efficacy and risks. Providers who recommend and also retail their own remedies also have a particular conflict of interest to sell those products.

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    10. Mike Jubow

      Forestry nurseryman at Nunyara Wholesale , Forestry consultants, seedling suppliers.

      In reply to Belinda Robertson

      Belinda, you are becoming a bit confusing now. Earlier you said,"herbal medicines approach is gaining traction with the consumer and is beginning to erode the traditional support base of chemical medicine".

      Now you are saying,"Most people follow and are happy to use chemical medicine". So, is herbal 'medicine'(?) having an effect and gaining 'traction' or not.

      Can you show us proof of that or is this just a thought bubble? Is there any evidence that herbalism is more efficatious than what you call 'chemical' medicine. Where is the hard and fast proof that herbalism has any benefit over 'chemical' medicine other than to line the pockets of the person selling the herbal concoctions?

      Is there any evidence that herbal 'remedies' are any better in any way other than the placebo effect? If you want to convince me to take your form of medicine on, you will need to convince me you have something as substantial as conventianol medicine.

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    11. Belinda Robertson

      Naturopathic Herbalist

      In reply to Mike Jubow

      Living in a low SES area I see a lot of sick people around...especially if I drop into the chemist. They are there in droves waiting for their medicines. I see our population getting sicker, not healthier, despite the figures on longevity. It is rare I see those people in my clinic. They choose pharmaceutical medicines and have little understanding of health. Herbal medicine is gaining traction and the fact we are having this conversation and there have been many articles recently written condemning…

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    12. Luke Weston

      Physicist / electronic engineer

      In reply to Belinda Robertson

      So let's just clear something up here.

      If you have, say, mild depression and you take St John's Wort and it is somewhat effective for mild depression then this effect occurs because the plant contains a chemical that goes into your brain and has an effect on the monoamine transporters, hence affecting reuptake of serotonin etc. It does not occur as the result of some sort of magical undetectable whole-plant spirit in the plant.

      If that were the case, it is highly suspicious that, say, paclitaxel or morphine or atropine, vincristine, nicotine or any thousands of other pharmacologically or toxicologically significant plant products maintain their biological activity when they're separated from their magical plant spirit.

      But you don't believe that? You believe that a plant contains some sort of magical force undetectable and uncharacterisable by medicine and its allied sciences, and this force is responsible for herbal medicine?

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    13. Luke Weston

      Physicist / electronic engineer

      In reply to Sue Ieraci

      ''Taking herbal preparations made in accordance with TGA GMP and with/under the advice of their healthcare practitioner and in accordance with the directions and contraindications for use should not be discouraged.''

      Even when these products, even with GMP, practicioner advice, directions and contraindications explained, cannot remotely assure a positive risk-benefit safety profile?

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    14. Luke Weston

      Physicist / electronic engineer

      In reply to Belinda Robertson

      What you're talking about here is not "natural medicine" - it's "supernatural medicine".

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  20. Leonie Rogers

    Physiotherapist and Author

    I've been a silent observer on this article, and there are two things to note about the conversation.

    The pro-herbal medicine group have stated the same things over and over again. Basically, "you need the whole herb for the whole person, but don't worry about knowing what's actually going on or whether it works, because it just does."

    The other side of the conversation (modern medicine) has said the same thing over and over again as well. ie. "Current science tells us that much medicine has come from herbal remedies, when those remedies have been studied, refined and quantified, and assessed for efficacy."

    One is based on tradition but resists investigation, while the other changes when evidence changes, because of investigation.

    I can happily say that I'll go with modern medicine. Known effects from known substances, backed up by research.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Leonie Rogers

      Well summarised, Leonie Rogers.

      Perhaps we could save valuable column space by numbering the standardised responses: No 1 and No 2.

      The people could then throw numbers at each other:
      ''It's No 1''
      "No, it's No 2''
      "Number 1 is right''
      ''It's not 1, it's 2''

      "1!!!"

      ""NO - 2!!!!!!!""

      (As Pythons would say, ''Is this the two minute argument or the five minute argument?")

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    2. Rotha Jago

      concerned citizen

      In reply to Sue Ieraci

      Mike, sorry I cannot supply you with a link. I was in business at the time and the legislation affected me and my suppliers. I also did my bit to try to stop it.
      I agree with previous comments that there are two ways of seeing health and illness and decisions about what you and your children will eat or take.
      Here is an example. One day a customer came into my shop with a present for me. A bag of oranges from her own tree. In thanking her I remarked that her children were fortunate as the oranges…

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    3. Leonie Rogers

      Physiotherapist and Author

      In reply to Rotha Jago

      Well, I do think there's two different cultures, but not in the way you're suggesting.

      And what precisely is "Ancient Wisdom?"

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    4. Mike Jubow

      Forestry nurseryman at Nunyara Wholesale , Forestry consultants, seedling suppliers.

      In reply to Leonie Rogers

      Leonie, Re; "And what precisely is "Ancient Wisdom?"

      Could it be something like, "I think, so, therefore it must be"?

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    5. Yosefine Deans

      Chiropractor

      In reply to Leonie Rogers

      Hi Leonie,

      Nice to hear from you. I didn't read anyone say that "don't worry about knowing what actually going on or whether it works, because it just does". Did someone say that?

      The form based on tradition, in my opinion, does and does not resist investigation. It does in the way that investigation is not yet sophisticated enough to prove everything you might need to just know. We would be fools to say we have reached the pinnacle of medicine, don't you think? And it does not resist in that…

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Rotha Jago

      Rotha Jago - medicine is VERY multicultural.

      The Chinese excel in areas like gastroenterology and Oncology.
      India has a lot of expertise in congenital heart disease and infectious diseases.
      Sri Lanka has a top centre for medical toxicology.
      Mexico has a strong paediatric research culture...

      (References available on request)

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    7. Yosefine Deans

      Chiropractor

      In reply to Sue Ieraci

      Hi Sue,

      I agree medicine is multi-cultural, all sorts of cultures partake these days. What I think Rotha means is, take yourself back a few hundred years and look at what various cultures were doing then.

      Sue, do you believe in one form of medicine to take over the world? It seems to me that you would like that.

      Let's keep comments respectful.

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    8. Leonie Rogers

      Physiotherapist and Author

      In reply to Yosefine Deans

      I'm a little hard put to know how to reply to this comment, Ms Deans.

      When you read the whole discussion, what you see is a pattern - which is as I've summarised it. Not those precise words, obviously, but the same sentiment.

      As far as my own stance, well I'd like to think that any health practitioner (I'm in allied health myself) is interested in evidence, not simply tradition. That's not arrogance at all, just good sense, and is of course, called evidence based practice.

      And of course…

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    9. Yosefine Deans

      Chiropractor

      In reply to Leonie Rogers

      Me again Leonie,

      Thanks for your comments which I enjoyed. My point about over emphasis on evidence is that anything not proven just now seems to be thrown out. Like thousands of years of traditional lore. We simply don't know everything there is to know so how can we only rely on use of evidence.

      Your comment on research is spot on and you misunderstand me there - I don't agree with research to prove a point either, unless it is to rival those that do use it that way like the pharmaceutical complies.

      As for your Indigenous friends, I would have thought they would prefer old ways to modern medicine. Have you asked them?

      Yosefine.

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    10. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Yosefine Deans

      Thousands of years of traditional lore can be dead wrong (artistoloic acid containing herbal medicines being toxic, not healing as tradition states, traditional medicines that contain lead and mercury, echinacea being next to useless for colds and flu's, the list goes on and on, again, see the links in the main article to research that documents this)

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    11. Leonie Rogers

      Physiotherapist and Author

      In reply to Yosefine Deans

      Research is all about finding the evidence to support a therapy. Or finding evidence that doesn't support a therapy so that therapy can be discarded. Health professionals should always be looking towards best practice - and be willing to change their practice as more evidence is sourced. We shouldn't be wasting our patients time with practices shown to be ineffective.

      A question for you: Why would my indigenous friends be any more likely to prefer "old ways" to modern medicine than anyone else? If you like, any person you meet has "old ways" in their family history, not just indigenous Australians.

      Most of us have moved on to evidence based health care, which is what this topic is all about, while others cling to a bizarre reverence for past practices that we now know are dangerous, or that we know do nothing at all. A number of the other posters have already highlighted this.

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    12. Sue Ieraci

      Public hospital clinician

      In reply to Yosefine Deans

      ''Thousands of years of traditional lore'' didn't come up with the notion that invisible displacements of spinal bones could cause ''nerve interference'' that would affect the function of all cells in the body, and be fixable my ''adjustment''.

      Modern science doesn't support that notion either.

      That doesn;t seem to stop many chiorpractors hanging onto those concepts today, though, does it Ms Deans?

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    13. Neville Mattick
      Neville Mattick is a Friend of The Conversation.

      Grazier: ALP Member at A 4th Generation Grazing Station

      In reply to Rotha Jago

      "I don't give the oranges to them" she said" I buy Allenburys Orange Juice because I know what is in it".

      That is interesting Rotha; that actions can become part of belief.

      Similarly the "legs on the chicken" which became a family habit.

      It plays like this; Newly-weds had a chicken roast one day.

      The Husband asked, "why do you cut the legs off the chicken to roast it?"

      Wife said - "because Mum did, that is why".

      Husband asked the same of Mother in law.

      Mother in law; "well I did it because Mum did".

      Husband curious about this answer went to the nursing home with his Wife to speak to her Grandma.

      He asked the same question of her.

      She replied; "well I always cut the legs of the chickens because my roaster was too small".

      Subsequent generations' but not always logical.

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  21. Laurie Willberg

    Journalist

    Mr. Musgrave seriously underestimates the knowledge base of users of herbal and non-pharmaceutical medicines. These patients are uber-educated and quite capable of looking up potential interactions between herbal preparations and pharma drugs, notwithstanding they are usually looking for ALTERNATIVES TO bulk drugs largely due to their adverse toxic effects. These consumers are likely to reject pharma drugs altogether. These consumers are quite capable of researching the optimum dose of herbal ingredients…

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    1. Terry J Wall

      Still Learning at University of Life

      In reply to Laurie Willberg

      Well said. Our health is not something that needs to be managed on our behalf. We don't live in a police state just yet.

      Last time I looked pharmaceutical and medical errors were the third greatest cause of death. Still trying to find more than 10 from herbal or other alternative causes. Give us a break.

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    2. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Laurie Willberg

      Sorry Laurie, all the research we have is that consumers are not "übereducated" and have serious misunderstandings about herbal medicines (see links in the main article)

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    3. Laurie Willberg

      Journalist

      In reply to Ian Musgrave

      Sorry Ian, but there are considerable databases available now relating to herbal and non-pharma medicines that you must be either ignoring or refusing to acknowledge. Notwithstanding, you are a chemist, not a herbalist, and not a medical practitioner. There is an enormous pretense that pharmaceuticals, for example, do not cause iatrogenic (drug-induced) disease or that educated folks are somehow stupid for rejecting them.
      As Mr. Wall above has observed, there have been no fatalities from herbal or nutraceutical supplements, we are entitled to make our own health care decisions, and that includes rejecting drugs for the numerous problems they cause.

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    4. Paul Rogers

      Manager

      In reply to Laurie Willberg

      Laurie wrote: ". . . there have been no fatalities from herbal or nutraceutical supplements".

      I would be surprised if there were not *thousands* of deaths, and even more chronic kidney conditions from aristolochic acid over time, a potent kidney and urological toxin and carcinogen and a popular ingredient in Chinese herbal medicines -- and who knows what else. (See Balkan endemic nephropathy.)

      Ann Intern Med. 2013 Mar 19;158(6):469-77. The epidemiology, diagnosis, and management of aristolochic acid nephropathy: a narrative review. Gökmen MR, et al.
      http://www.ncbi.nlm.nih.gov/pubmed/23552405

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    5. Michael Bunce

      ARC future fellow researching in the fields of ancient DNA and wildlife forensics at Curtin University

      In reply to Paul Rogers

      Paul - you are spot on... the notion that herbal medicines are 'harmless' and have caused "no fatalities" is completely wrong. Taiwan is known as the urinary tract capital of the world and there is strong evidence this is linked to the frequent consumption of the herb Aristolochia. See; http://www.pnas.org/content/early/2012/04/03/1119920109.

      Laurie - you don't live in a police state and are free to take any herbal product you like (including Aristolochia) - but don't we all agree that when there are proven detrimental effects that the wider public should be warned of the very real risks once they are established? Using your arguments should we remove warnings from tobacco products too on the grounds that what we consume doesn't need to be "managed"?

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Laurie Willberg

      Laurie Willberg, not a herbalist, says ''These consumers are quite capable of researching the optimum dose of herbal ingredients''

      and yet the herbalists here are saying that all the chemicals in the herbs and the concentrations in each dose are unknowable, or even don't need to be known because the herbal remedy is treating the ''whole person, not the illness'..

      Confusing, isn't it?

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    7. Sue Ieraci

      Public hospital clinician

      In reply to Laurie Willberg

      ''St. John's Wort has actually outperformed commercial anti-depressants in quite a number of studies and these consumers know it. ''

      Not so.

      St John's Wort IS a commercial antidepressant, which only works for mild depression.

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    8. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      ''Still trying to find more than 10 from herbal or other alternative causes. ''

      Mr Walls, I;m still trying to find more than 10 cures from all those supplements that you and others sell.

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    9. Paul Rogers

      Manager

      In reply to Michael Bunce

      MIchael, yes, I was being conservative. If one includes Chinese cohorts, the numbers could be in the hundreds of thousands.

      It would be interesting to know how much Aristolochia is, or was, prescribed by herbalists and naturopaths over time in Australia, and what possible adverse effects have occurred. Sounds like a good subject for a PhD in pharmacology or toxicology to me.

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    10. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Terry J Wall

      Hi Terry I have put up a graph on my twitter that may answer your questions. Deaths and risks in Australia. You have many times greater chance of being killed by lightning than by complementary medicines.

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    11. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Laurie Willberg

      Hi Laurie,
      For your info.
      De Smet (1996) also studied hypericum extract in opposition to standard synthetic antidepressants. In his study, he used "the comparator drug in daily amounts below or at the lower end of the usual dose range". All of these studies lasted less than six weeks and as De Smet noted that it takes at least two to four weeks of taking St. John's Wort for it to produce some noticeable effects. In this study, the beneficial effects of St. John's Wort appear to be equal to…

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    12. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Laurie Willberg

      Laurie, this is another there are many more.
      Hypericum extract WS ® 5570 for depression--an overview.
      RESULTS:
      In randomised, double-blind, controlled clinical trials the antidepressant effect of the drug was superior to that of the placebo and at least comparable to that of paroxetine. The beneficial effect of WS(®) 5570 is particularly pronounced with respect to the core symptoms of depression. There is evidence that the drug may also be effective in moderate to severe depression and in prophylactic continuation treatment after recovery from an acute episode.
      Int J Psychiatry Clin Pract. 2013 Nov;17 Suppl 1:1-7. doi: 10.3109/13651501.2013.813554.

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    13. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Paul Rogers

      Paul yes overseas unregulated and illegal products such as Aristolochia finding there way into Australia are of concern. However the TGA is always looking after us in regard to this. Unfortunately the system is not perfect and contaminations may happen. Only last year 25-Jul-2013
      Australian firm Ascent Pharmaceuticals issued a recall of one batch of paracetamol after concerns bottles may contain a foreign tablet.

      The good news Paul is that Naturopaths and Western herbal medicine practitioners…

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    14. Laurie Willberg

      Journalist

      In reply to Paul Rogers

      Speculation and "narrative review" with respect to what is essentially a contaminant, and this is supposed to panic everyone who uses any herbal product? Are you aware of the hundreds of thousands of patients whose kidneys have been damaged by blood pressure medications? At any rate, China's reputation for supplying "safe" anything is debateable (another example, melamine contamination of ingredients imported for pet food manufacturing).

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    15. Laurie Willberg

      Journalist

      In reply to Michael Bunce

      How about warnings on loaves of bread and other wheat-laden products warning of gluten sensitivity? Or warnings that products containing sugar can cause metabolic syndrome and diabetes? Maybe huge banners in front of fast food outlets that say "eat crap, feel like crap"?
      Any way you slice it or dice it, herbal products stack up to be far safer than pharma drugs.
      The vast majority of people who use herbal products instead of drugs are well-educated and more than capable of researching the substances and scope of usefulness without a pharma-backed Nanny censoring their freedom of choice.

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    16. Laurie Willberg

      Journalist

      In reply to Russell Setright

      Thank you for those, Russell. And there are hundreds of thousands of patients and herbalists/natural health care practitioners who continue to use it/prescribe it confirming the results of not only this one substance but hundreds more.

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    17. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Ian Musgrave

      Ian great work from your University another first for Australia and another one for herbal medicine (standardized extract) not a single chemical drug.

      University of Adelaide research has shown for the first time that grape seed can aid the effectiveness of chemotherapy in killing colon cancer cells as well as reducing the chemotherapy's side effects.

      Ker Yeaw Cheah, Gordon Stanley Howarth, Susan Elaine Putnam Bastian. Grape Seed Extract Dose-Responsively Decreases Disease Severity in a Rat Model of Mucositis; Concomitantly Enhancing Chemotherapeutic Effectiveness in Colon Cancer Cells. PLoS ONE, 2014; 9 (1): e85184 DOI: 10.1371/journal.pone.0085184

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    18. Ross Hennessy

      Herbalist

      In reply to Belinda Robertson

      I'm not sure where you all practice, but I'm in Europe. I buy herbal medicines that are tested, and batch numbered. I know the exact quantities of the chemicals involved, I know the necessary dosage, I know the research and I know and see the results.
      The ignorance to this subject amuses me, thousands upon thousands of people have died taking pharmaceuticals but that is allowed because they have gone through clinical trials and that is costly!!. Try to find out how many people have died from being prescribed a herbal medicine? I say prescribed because herbal medicines should be taken with care, they are chemicals and used correctly have amazing effects. They need control and should not be taken unless you know what you are taking and if is from a quality assured supplier.

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    19. Belinda Robertson

      Naturopathic Herbalist

      In reply to Ross Hennessy

      Hi Ross,
      I purchase my herbs through the Herbal Extract Company in Sydney. Great company been in the business for generations.
      You can check out their web site. I did some study in France with a few Irish herbalists. You seem to have a good strong Herbal Medicine contingent in Ireland. Thanks for entering this conversation. This will be my last posting on this conversation.
      Best regards,
      Belinda

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    20. Paul Rogers

      Manager

      In reply to Ross Hennessy

      Ross said: "They need control and should not be taken unless you know what you are taking and if is from a quality assured supplier. "

      You got it right there. How do we know this when someone calling themselves a herbalist or naturopath prescribes something in a bottle, made up by themselves. Do they understand the basics of pharmacology and toxicology, or even evidence-based medicine? In addition, how can they guarantee the quality of the product and the supplier?

      I was acquainted with a 'naturopath' who called herself 'doctor', and frankly, after getting to know her somewhat well, I was horrified that she actually treated people for serious illnesses. Where is the diagnostic training for a start?

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    21. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Paul Rogers

      Hi Paul,
      Another example of an effective herb for a debilitating condition. As many comments on this page are touch less than positive about herbs I thought I would ask you what are your thoughts about this one?

      The studies using butterbur are very promising and many have reported good results. As this is only a herb does this mean that migraine sufferers should remain in pain until it is worked out how to make a drug from this herb? As with all medications continuing evaluation is essential…

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    22. Sue Ieraci

      Public hospital clinician

      In reply to Belinda Robertson

      Thank you, Ms Robertson.

      I'll remember that next time I am required to use my knowledge and expertise to assist someone.

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    23. Russell Setright

      Author & Medical writer at Life Survival Training

      In reply to Paul Rogers

      Paul
      In Australia it is against ALL professional bodies rules to call yourself Doctor and disciplinary action is and will be taken against anyone who does, and this includes loss of accreditation, health fund recognition and ATO GST status. Also, her calling herself a Naturopath without accreditation is fraud and is also contrary to regulations under the NSW health, code of ethics for unregistered health practitioners.

      The only doctor of Naturopathy degree are offered by some universities in the USA and graduates also have to pass the states board medical examinations. In Australia the surgery component of the Naturopathic course is not in our curriculum. And I think thats a very good thing.

      The Bachelor of Health Science (Naturopathy) offered by some Australian Universities is the main course offered in Naturopathy. However, this does not give the graduate the right to call themselves doctor. Naturopaths are NOT medical practitioners.

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    24. Paul Rogers

      Manager

      In reply to Russell Setright

      Russel, yes I suspected as much, and this was about 15 years ago and I think she did have some sort of certificate course qualification. How about calling yourself a 'herbalist'? What are the connotations of that?

      I am not a complete sceptic on these matters. If something is safe and effective, I don't care what 'stream' it comes from as long as it passes scrutiny.

      But the other thing that bothers me is the idea of even qualified 'naturopaths' treating people for illness without the diagnostic training of MDs -- and the years of practical training that goes with that. How much training in diagnosis is provided in a naturopath course?

      Further, as far as I can determine, there are only a few somewhat reliable naturopathic/herbal remedies. Does any naturopath ever say: "sorry, not got anything that works for that.".

      Or (yes I'm a little cynical) do they tell the patient they must be allergic to wheat, milk, or yeast?

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    25. Luke Weston

      Physicist / electronic engineer

      In reply to Russell Setright

      However there is actually no legal protection of the title of doctor. There used to be, and then the government got rid of it! Bizarre.

      While self-regulation in some professional bodies may regulate this, this does not affect all the shonks and quacks out there with no regulatory professional body, and any of them are completely free to call themselves doctor.

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  22. Julie Fisher

    Professor of information systems at Monash University

    Thank you for your article. One issue that is not raised and I know you have limited words, is the labeling or lack there of, of 'herbal' medicines. I speak from experience. My sister was prescribed a herbal cream which turned out to be a highly concentrated steroid mixed with green food dye from which her skin has never recovered. She was told it was squeezed from the leaves of a tree. The case went to court, the Chinese herbalist was found guilty was she fined and she is still practicing. Prescribed medicine and supplements sold in pharmacies must be properly labelled, Not so herbal medicine sold by Chinese herbalists.

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    1. Yosefine Deans

      Chiropractor

      In reply to Julie Fisher

      Dear Julie,

      Thank you for your fresh comment. I agree that labelling is a good idea and it needs to be honest and thorough. Sadly, pharmacies don't always label well either. Lucas Paw Paw Ointment only lists the paw paw as the active ingredient. There is no mention that it is in a petroleum base which put me off when I found out. I asked them if they would consider labelling it fully but they said they weren't required to. As for the Chinese Med situation, how awful! I guess there is a culture clash too. Be smart enough to know what not to take! I disagree - protect the innocent for sure.

      Yosefine.

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    2. Ross Hennessy

      Herbalist

      In reply to Julie Fisher

      Good point Julie, I believe that anyone who purposely misleads the public in the sale of any medical product should be heavily fined, jailed and not allowed to practice in that field again. I just launched a database website www.bluherbal.ie in Ireland which lists only qualified herbalists, shows details of their insurance and what association they belong to. It is so important that herbalists are associated to a registered body and hold insurance and are accountable for their actions.
      The Chinese…

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  23. Luke Weston

    Physicist / electronic engineer

    "No trained herbal practitioner would argue that herbs are medications

    Telling us "The simple fact that herbal medicines are drugs" is elision at best, and deliberately misleading at worst."

    I would certainly hope that none of these people are in any position to be supplying, recommending, dispensing, prescribing or administering any kind of "medicine" to any patient, whether it's enchanted tap water, willow bark or hemlock.

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  24. John Zigar

    Engineer, researcher

    Suffering high blood pressure (258 over 150) I decided to use Hawthorn extract. My blood pressure started to drop (over time). When I commenced medication prescribed by my GP (Codiovan) I ceased taking Hawthorn extract. My blood pressure went back up and my hair started to fall out which is a common side effect of Codiovan. When I wrote to Novartis requesting statistics on dosage, length of use and hair loss, they wrote back saying that they had no data on this. Unbelievable, and I thought that drug…

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    1. Ross Hennessy

      Herbalist

      In reply to John Zigar

      Very true John, sorry you had to go through that ordeal, if only everyone visited a Naturopath or Herbalist every year for a check up. Prevention is so much better than cure, but we always wait until we feel the condition has set in, then its time for a pill. Pharma companies do not like prevention, no profit in that sort of thing...

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    2. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to John Zigar

      Hair falling out is a very rare side effect of Co-diovan (Valsartan, hydrochlorothiazide), less than 1% incidence (which is why statistics on incidence and dosage are unavailable, it is too rare for meaningful data).

      Spironolactone is NOT a thiazide diuretic, it is an anti-aldosterone drug. It is not associated with causing diabetes, in fact it is being trialled as an effective drug in people with type II diabetes with resistant hypertension.
      http://www.ncbi.nlm.nih.gov/pubmed/24107738
      http://www.ncbi.nlm.nih.gov/pubmed/24047125

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    3. John Zigar

      Engineer, researcher

      In reply to Ian Musgrave

      Thanks for your replies, Ross and Ian.

      Ian, you are correct, Spironolactone is not a thiazide, my mistake. However, the use of Spironolactone can bring on gout. Spironolactone can also elevate blood sugar levels. Since I did not have diabetes or any signs of it prior to taking this medication, and I have not changed my diet or lifestyle, this drug must have brought it on. My blood sugar levels before taking Spironolactone were normal. You can argue whether the chicken was first or the egg, however…

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    4. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to John Zigar

      "Since I did not have diabetes or any signs of it prior to taking this medication, and I have not changed my diet or lifestyle, this drug must have brought it on."

      This is incorrect reasoning. Type II diabetes incidence increases with age. Diet and lifestyle can definitely significantly increase your risk, but you can also develop type II diabetes without these risk factors (just like non-smokers can develop lung cancer). No link between spironolactone and diabetes has been found (again, it is…

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    5. Laurie Willberg

      Journalist

      In reply to John Zigar

      Did your GP ever discuss drug-induced nutrient depletions with you?
      You may want to reference this database of drug-induced nutrient depletions
      http://naturaldatabase.therapeuticresearch.com/ce/ceCourse.aspx?s=ND&cs=&pm=5&pc=11-108&AspxAutoDetectCookieSupport=1
      "Absorption

      Drugs that change the environment in which nutrients are absorbed have the potential to cause nutrient depletion over time. For example, nutrients that require an acidic environment in the gut for optimal absorption can…

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    6. Rotha Jago

      concerned citizen

      In reply to Ian Musgrave

      What are we trying to prove?
      That specific chemicals (which are only specific on the label)
      are better than herbal tinctures and tablets?
      Herbal medicines and teas have been produced in Germany under Government supervision and with specified ingredients for many years. But this same argument goes on there too.
      Homeopathic remedies are very popular in Europe, and in Australia they are popular for use on animals, being cheap, harmless and effective.
      In a large pharmacy in suburban Brisbane I…

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    7. Ross Hennessy

      Herbalist

      In reply to Rotha Jago

      If you want to learn about disease go to your doctor, if you want to learn about health go to your Naturopath.

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    8. John Zigar

      Engineer, researcher

      In reply to Ian Musgrave

      You're probably right Ian, all the side effects from the medication came about by pure coincidence.

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