HEART RUPTURE, brain damage, failure of the kidneys, liver, heart and breathing — even death. This reads like a list of complications caused by virulent disease.

In fact, these are all adverse effects suffered by children taking herbal remedies, as reported in the European Journal of Pediatrics earlier this year.

The use of herbal medicines has soared, and the business is now worth around £75 million a year. Many factors have contributed to this, including dissatisfaction with the rushed consultations in an overstretched NHS. While the average GP is allocated only six minutes per patient, alternative practitioners have more time: this opportunity to chat and obtain a holistic picture, both physical and psychological, is immensely valuable.

But although herbs are used safely by, and undoubtedly help, millions of people, they are not the safe panacea that many assume.

First, let me declare my hand — as a consultant anaesthetist I could be assumed to feel antipathy towards herbal medicine. The fact is that many medical herbalists are wise, careful practitioners who have been through a structured training and accumulated years of experience — and who make up their own remedies for individual patients using fresh and dried herbs. Conventional doctors’ concern is largely over the lack of control, regulation, and safety assessments of unqualified practitioners and over-the-counter herbal supplements.

It is often wrongly assumed that herbs are purer than conventional medicines. Many conventional medicines also have their origins in plants — digoxin from the foxglove, morphine the poppy, and aspirin the willow. The manufacturing process includes isolating the active ingredient and eliminating contaminants. Some herbal products have, until now, escaped this process, and reports abound of contaminants including lead, arsenic, mercury, aspirin, paracetamol and potent heart drugs. Last year the Journal of Internal Medicine reported contaminants such as steroids, epilepsy drugs and tranquillisers.

In January the use of the herb kava was banned in the UK after 70 reports of liver damage. The ban follows the EU’s tightening of the legislation around herbal remedies. By early next year all herbs must be registered before they are marketed; the manufacturers must provide evidence of medicinal use for at least 30 years, ten of them within the EU. There are also regulations to ensure quality control, reporting of adverse effects and proper labelling of contents, and a requirement to provide clear details of doses on labels.

Although some in the herbal industry argue that the laws will eliminate products and cause businesses to fold, many, such as the National Institute for Medical Herbalists (NIMH), agree with the European Directive on Traditional Herbal Medicinal Products, because it will improve patient information and ensure quality control. (Indeed, when the Medicines and Healthcare Products Regulatory Agency — MHPRA — asked concerned manufacturers to send in products that they feared might be banned, more than 200 were sent in, but fewer than ten may face a problem.)

But this will not tackle the thorny issue of safety tests — clinical tests will not be mandatory under the EU law.

No medicine, alternative or conventional, is free of side- effects. Conventional medicines undergo a battery of rigorous tests over decades. A strict protocol also exists for reporting adverse effects — doctors must report these to the Committee on Safety of Medicines (CSM), which has the power to prohibit drugs. The CSM welcomes reports of side-effects from herbs, but many doctors do not know that their patients are taking these remedies, so reports are made of only a minority, such as the CSM report of a woman who had suffered severe blood loss from a remedy containing absinthe.

While well-trained herbalists report adverse reactions to the MHPRA under a similar reporting scheme, unqualified practitioners often fail to do so. A study in the British Journal of Clinical Pharmacology found additionally that patients were far less likely to report adverse reactions to herbs than to conventional drugs.

There is a centre in Kew Gardens, southwest London, which carries out safety tests on herbs. Staffed by doctors from Guy’s Hospital Poisons Unit and Chinese doctors, it carries out tests on commonly used herbs. However, the number of products awaiting scrutiny is huge (tests on one substance alone take years).

NIMH does not believe there is a need for safety tests. “Herbal remedies are different from conventional medicines — the concentrations used are far lower, and they’ve been used for years,” says Alison Denham, from NIMH. “Safety tests cost millions. Drug companies have huge budgets, but manufacturers of herbal remedies don’t, so requirements for tests would lead to bankruptcy. Adverse effects are largely due to contaminants.”

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