Herbal medicines have become increasingly popular in Western countries in recent years, with many patients using them regularly - often without their family physician's knowledge.
More than 50% of Australians now admit to using complementary or herbal remedies. In the US, the figure is in excess of 30% of those surveyed - and the industry is worth several hundred million dollars annually.
Forensic Significance of Traditional Herbal Remedies
In a recent review article on the potential forensic significance of Traditional Herbal Medicines published in the Journal of Forensic Sciences, Dr. Roger W. Byard, M.D. of the University of Adelaide in Australia states, "There's a false perception that herbal remedies are safer than manufactured medicines - when in fact many contain potentially lethal concentrations of toxic chemicals like arsenic, mercury and lead."
In addition to organic toxins that occur in the natural state, traditional herbal preparations may contain highly toxic chemicals and heavy metals - which could precipitate illness, aggravate pre-existing conditions or even result in death. An analysis of 251 Asian herbal products found in United States stores identified arsenic in no less than 36 of them, mercury in 35 and lead in 24 of the products.
On occasion, taking herbal remedies which one does not inform one's treating doctor about may result in symptoms and signs that confuse the clinical features of a patient's illness. This creates a situation where it becomes difficult for the doctor to make a correct diagnosis.
Lack of Quality Control
Moreover, the preparation of many herbal remedies is poorly regulated - so that they may become contaminated or even adulterated with prescription drugs. "Herbal medicines are frequently mixed with standard drugs, presumably to make them more effective. This can also have devastating results," Professor Byard says. And those who take these drugs are not aware of what goes into many of them.
For example, the herbal medicine known as Chan su, used to treat sore throats, boils and heart palpitations, contains the venomous secretions of Chinese toads, which can cause cardiac arrests or even comas. Some Ayurvedic preparations used to treat asthma contain an appreciable amount of prednisolone, a steroid, which can have serious adverse effects if taken by mouth over a long period. Cushing's syndrome, a hormonal disorder, has also been linked to the ingestion of steroids and herbal cures mixed together
Reaction with Common Medicines
Patients who do not inform their family doctor that they are taking herbal preparations can be at risk of the combination of these medicines resulting in adverse side effects. St John's Wort, for example, can reduce the effects of warfarin and cause intermenstrual bleeding in women taking the oral contraceptive pill. Garlic and Gingko biloba also increase the risk of bleeding in someone taking anticoagulants. Some herbal preparations such as borage oil and evening primrose oil lower the seizure threshold in epileptics.
The American Society of Anesthesiologists has recommended its patients discontinue using herbal medicines at least two weeks before surgery because of the risks of herbal and drug interaction, including an increased chance of bleeding.
In one documented case, a five-year-old boy who had ingested 63 grams of "Tibetan herbal vitamins" over a period of four years was diagnosed with lead poisoning. Other side effects of herbal medicines can include liver, renal and cardiac failure, strokes, movement disorders, muscle weakness and seizures.
Sanjiva Wijesinha - Dr. Sanjiva Wijesinha, Associate Professor at Monash University medical school, writes on health, travel and medical topics.
