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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Sunday 3rd July 2011

One of my Google Alerts threw up an interesting article on the regulation of herbalists.

Google, it seems to me, produces a great many new products but then leaves people to discover them rather than promoting them. That’s not a bad plan, I suppose, because it means that some of their dafter ideas disappear without trace. But it does mean you may not have come across Google Alerts.

In essence, it allows you to set up an automated daily search for search terms that are of particular interest. Of course, you could easily do a search every day but the point of an Alert is that it only gives you changes that have occurred in the last 24 hours. It’s not perfect, you can’t be sure it has collected everything. Sometimes, the date on a news story makes it clear that the Alert is several days behind the times. That is because it records what has changed in Google’s index in the past day rather than what happened.

Plus, it is not without risk. Google gets better all the time at dealing with the variety of bad boys who inhabit the Internet with the hope of making mischief or money but there are times when it doesn’t catch all of them straightaway. This means you have to look closer at the Alert results in the email and decide whether it seems to be a genuine entry or an attempt to catch people and infect their computers.

But, in spite of the limitations and drawbacks, Google Alerts does produce some interesting stuff, like the story about the regulation of herbalists that I mentioned at the start.

Aristolochia clematitis, birthwort

Aristolochia clematitis, birthwort

Earlier this year the EU introduced regulations intended to ensure that anything offered as a ‘herbal medicine’ had been properly produced and that claims for its efficacy could be justified. One of the drivers for this new regime was the problems of aristolochic acid found in some Traditional Chinese Medicine (TCM) products. The concern was that individuals had their own recipes for remedies but those remedies had identical names to the products of many others. In short, no-one knew what they were actually getting because the information on the product was not reliable.

This is not a new problem. I think it was Thomas Johnson, early in the 17th century, who complained about apothecaries who relied on plants bought from female plant collectors with limited ability to distinguish one plant from another.

Now, the subject of the regulation of practitioners is going around, again. The arguments about regulation of complimentary treatments, in all forms, have been discussed for a good many years and, yet, there is still no resolution. On the one hand, many practitioners say they want to be regulated because they know that there are ‘cowboys’ out there, just as there are in any business. On the other hand, supporters of ‘proper’ medicine say that, unless these therapies are subject to the same standards of proof as mainstream medical practice and medicines, regulation would give credibility to things that, when studied turn out to be no better than placebo.

‘Pulse’ is a magazine aimed at health professionals and, specifically, GPs. Its latest edition has an op-ed piece by Gary Minns, president of the Register of Chinese Herbal Medicine (RCHM). Mr Minns says that regulation of practitioners is the right way forward in order to weed out those who do not meet the requirements of the RCHM. He also, and this is key, acknowledges that the evidence for herbal medicines is not good enough because the trials, to date, have been flawed.

So, the problem remains. How do you regulate an industry that doesn’t have any proven standards against which to measure ability? What matters is more what the substances do rather than who uses them.

And that brings us back to the regulation of herbal products which was widely condemned by people in the complimentary medicine business.

Digitalis purpurea,foxglove

In the late 18th century, when William Withering wanted to investigate the rumours concerning the use of foxgloves, plants in the Digitalis genus, as a diuretic to treat the dropsy, he knew that the first thing to do was obtained a consistent supply of the plant so that the active ingredients could be predicted with accuracy over a long period. Once he had that consistent supply he went on to conduct one of the first, and still one of the best, trials of any medication.

As a result of Withering’s work and his willingness to publish full details of his experiments on patients even when those experiments resulted in death of the unknowing subject, we now know that extracts from Digitalis are a very useful medication for certain heart conditions and, because we can produce extracts with precisely known strength, we can overcome the problem of the narrow therapeutic index of digoxin which means that even a small overdose can be fatal.

No-one, today, thinks of digoxin and the other medications extracted from Digitalis as ‘herbal remedies’; they are mainstream medications. On balance, I agree with Dara O’Briainn, the Irish comedian, on this one. O’Briann says the ‘old fashioned herbal remedies’ which worked are, today, called medicines and everything else is just vegetable soup.