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Caution on herbal medicine

From Dr David Church

(no known conflicts of interest)


I am afraid I don't agree with the advice the researchers have extrapolated from their study of certain herbal medicines (News, 20 April).

They appear to have shown that a certain preparation of willow bark and a certain preparation of devil's claw are both effective analgesics or anti-inflammatories in back pain.

This finding cannot be generalised to any preparation of those items other than the preparation tested, and certainly not to other herbal medicines such as those


This is a logically false finding and does not back up their advice that herbal medicines should be used first-line.

A new drug should never be used first-line until it has been shown to be both as effective as, and as safe as, known therapies.

In this instance, the side-effect profiles of known NSAIDS are better known and would be the standard for comparison. In the case of willow bark, this is not news anyway.

It is well-known that it contains salicylate products, from which aspirin was developed. Until the other constituents are known and their side-effects quantified, it is much safer to use aspirin with its known effects, at least until a valid and unbiased comparison can be studied.

The implication that the herbal products are safe and free of side-effects is irresponsible.

Willow bark extracts containing salicin interact with numerous other drugs, should not be used alongside warfarin except with care, and should be avoided in the presence of ulcer-related gastritis.

There may well be safer NSAIDs in the BNF already, which should be used first-line.

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