Edzard Ernst looks at the conflict between science and practice in herbalism
There is a big difference between using a scientifically proven herbal medicine for a specific condition and consulting a traditional herbalist, and thus receiving herbal therapy via this route.
No good evidence exists to show that the latter approach does more good than harm. These individualized prescriptions are based on obsolete notions straight from the dark ages. In contrast, some herbal medicines are supported by sound evidence. For instance, St John's wort is scientifically proven as a treatment for depression [1].
In practical as well as theoretical terms, the difference between the two forms of herbal medicine could hardly be greater. The first approach might best be called ‘traditional herbalism'. If a patient is depressed and consults an herbalist, he is unlikely to prescribe St John's wort. Instead he would concoct a tailor-made mixture of several herbs based on pre-scientific assumptions of health and disease. Few rigorous tests of ‘traditional herbalism' exist, and the totality of the published evidence fails to show that it is effective or safe [2].
The second approach might best be called rational phytotherapy [3]. It uses effective herbal extracts for defined conditions, much like GPs use synthetic drugs. Several herbal medicines are supported by reasonably solid evidence [4]. Therefore, the application of such a preparation is fully in line with the principles of EBM.
British herbalists are currently lobbying to be regulated by statute. If they fail, they will soon not be able to prescribe many of their tailor-made mixtures. They say this would be an unfair blow to ‘traditional herbalism' e.g. European, Chinese, Tibetan, Kampo herbalists. However, herbalists had many years to test their traditional approaches. Instead of submitting their practice to proper scientific examination, they elected to spend their funds on lobbying and spinning the evidence. In particular, Prince Charles has been nobbling health ministers which is hardly his constitutional role. Now herbalists may find that political pressure is no substitute for sound evidence and royal obsessions can be no replacement for science. The end-result might be that we lose some of elements of those traditions. This might upset Prince Charles, but I doubt that it will be a blow to effective healthcare.
The message for GPs is simple: the next time you are tempted to send a patient to a traditional herbalist, think twice.
Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter
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