Herbal remedies and drug interactions: an issue overlooked by health authorities

Holden and Joseph summarised the current state of interactions between herbal remedies and antirheumatic drugs in the December issue of Expert Opinion on Drug Safety [1]. They highlight an area in public health and vigilance that has been stunningly overlooked – at least by certain health authorities. It is an issue that is not limited to antirheumatic drugs, but covers the whole pharmaceutics spectrum.

A large number of people in the medical community and elsewhere are aware of the dangers that herbals can produce. A Google search done on 26th November 2005 using the words ‘herbals’ and ‘drug interactions’ yielded over 1.85 million hits. Many articles warn of interactions [101]. So the problem is not unrecognised.

In the US, herbals are minimally regulated. The FDA may only pull a product from the US market if it is proven to be dangerous (see a fine commentary from the Mayo Clinic [102]). Many of the reasons for the lack of regulation in the US appear to be largely political, dating back to a 1994 law passed by the Congress restricting the FDA’s oversight of herbals.

The EU seems to be a step ahead with a working group established in 1997 and a recent directive (2004/24/EC) on the legislative framework for herbal medicines. The working group continues now as a permanent committee [103].

Although no one doubts the usefulness of certain herbals, neutraceuticals, alternative medicines and so on, the public and the medical profession need assurances regarding their safety and efficacy. The marketplace is not able to regulate these issues any more than it could for drugs.

Perhaps the only saving grace in all of this is, as a colleague remarked to me some years ago, many of the neutraceuticals have such a minute amount of the actual active ingredient that they are too inert to do any harm (or any good either).