The popularity of herbal remedies rests, in large part, on the perceptions of these substances as “natural,” a vague, nearly meaningless term often mistakenly understood to mean “safe.” The idea that eating parts of plants, singly or in combination, can have significant health benefits with little to no risk is one of the irrational cornerstones of alternative medicine. On the other hand, the idea that plants contain compounds which can have both beneficial and adverse health effects is a well-established and generally accepted fact. Herbal remedies very likely do have health benefits, we simply rarely have the data to identify these or the associated risks with enough certainty to justify claims made for them or clinical use of them.
Despite this, such remedies are not infrequently used by patients, often without the knowledge or guidance of healthcare professionals. Exactly how popular herbals are is unclear, but individual surveys suggest a small but significant number of patients use them. I recently ran across one such study, which illustrates the use of herbal remedies by human HIV patients and also sheds some light on the attitudes of such patients and on the potential risks of this behavior.
Vazquez Hernandez, M. Hurtado Gmez, MF. Blanco, JR. The influence of alternative medicine in highly active antiretroviral treatment. Farmacia Hospitalaria 2009;33(1):31-6.
Highly active antiretroviral treatment (HAART) is an approach which significantly reduces HIV morbidity and mortality and improves the quality and length of patient’s lives. While not a cure or devoid of side effects, it is a highly effective treatment that has had a tremendously positive impact on the well-being of people infected with HIV. As with most incurable conditions, however, there is a subpopulation of patients who are interested in alternative therapies to replace or augment conventional care. This study found 16.6% of the HIV patients surveyed used 1 or more presumably medicinal plants.
37.5% of these people thought of these plants as a form of medication, which is the appropriate perspective to take on herbal remedies, apart from the lack of evidence to document safety and efficacy for many of them. However, another 37.5% of the patients did not know medicinal plants could have any side effects, and none of the patients realized that these agents could interfere with the HAART that was so vital to their health. 62.5% of the patients did not know what the herbal remedy they were taking was, could not say what it was for, and were taking it on the advice of someone who was not a healthcare professional.
A variety of herbal agents were used, with grapefruit, milk thistle, and Echinacea being the most common. Though information about safety and possible interactions with pharmaceuticals is extremely limited for most herbal products (no literature was found for 54% of the agents used), some published evidence of negative effects of HAART was seen for 46% of the agents reported, including the three most common ones. The authors concluded:
Patients undergoing HAART regularly use medicinal plants and this often occurs without the knowledge of the doctor or pharmacist. There is evidence that herbal preparations can cause pharmacokinetic and pharmacodynamic interactions that represent a potential risk in patients undergoing HAART…
The population in general and the patients perceive these substances as healthy. The patients are not aware of the adverse effects that these can sometimes produce and that they can even cause HAART to fail. The reasons given for the consumption of medicinal plants is that the patients believe that these increase the efficacy of their treatment, improve their quality of life, reduce the adverse effects of HAART and give them a feeling of control.
This is a summary which probably applies equally well to many of groups of patients. Herbal remedies with significant but poorly understood physiologic effects can impact, both positively and negatively, the health of people who take them, but most people know little about what they are taking or why, do not understand that the benefits are unclear and that there are possible risks, and most rely on the advice of people other than their primary healthcare team. If herbal remedies are to find a place as effective medicines, we need to develop the research base to understand their effects and we need to educate patients and healthcare professionals about the potential risks and benefits and interactions with other therapies. This, of course, requires debunking the fallacy that such products are inherently safe because they are “natural.”