Underestimating the Toxicological Challenges Associated with the Use of Herbal Medicinal Products in Developing Countries

Vidushi S Neergheen-Bhujun

doi:10.1155/2013/804086

Abstract

Various reports suggest a high contemporaneous prevalence of herb-drug use in both developed and developing countries. The World Health Organisation indicates that 80% of the Asian and African populations rely on traditional medicine as the primary method for their health care needs. Since time immemorial and despite the beneficial and traditional roles of herbs in different communities, the toxicity and herb-drug interactions that emanate from this practice have led to severe adverse effects and fatalities. As a result of the perception that herbal medicinal products have low risk, consumers usually disregard any association between their use and any adverse reactions hence leading to underreporting of adverse reactions. This is particularly common in developing countries and has led to a paucity of scientific data regarding the toxicity and interactions of locally used traditional herbal medicine. Other factors like general lack of compositional and toxicological information of herbs and poor quality of adverse reaction case reports present hurdles which are highly underestimated by the population in the developing world. This review paper addresses these toxicological challenges and calls for natural health product regulations as well as for protocols and guidance documents on safety and toxicity testing of herbal medicinal products.

Highlights

With the burst in the use of herbal medicinal products (HMPs) globally, either for primary treatment or as complementary and alternative medicine, safety and efficacy of herbal medicine have become a public health concern
It has been difficult to make reliable estimates of ill health caused by herbal products because (i) the perception that “natural” equates to “safe” and herbal medicine users would not realise that a herbal remedy may be responsible for adverse symptoms they have experienced; (ii) the lack of communication between patients and medical practitioners regarding the use of herbal medicine; (iii) the presence of low-grade herbal products on the market, and (iv) the supply of counterfeit products
The World Health Organisation (WHO) estimates that 80% of Asian and African populations rely on traditional medicine as the primary method for health care needs

Summary

Introduction

With the burst in the use of herbal medicinal products (HMPs) globally, either for primary treatment or as complementary and alternative medicine, safety and efficacy of herbal medicine have become a public health concern. Whilst conventional medical science has powerful methodologies for proving efficacy, ensuring quality, standardising good manufacturing practices, testing for safety, and conducting postmarketing surveillance for adverse effects, similar guidelines are lacking for herbal products; the same has not been extended to traditional herbal medicines despite these having been embraced by different cultures and regions. Case reports have played a crucial role in alerting the scientific community on the adverse effects of therapeutic interventions [36, 37] This is true for herbal medicines, many of which have a long traditional use but without ever having been submitted to formal tests of safety compared to conventional medicines. Many of the case reports in the developing countries are not properly recorded, limiting appropriate conclusion thereby contributing to increasing adverse clinical effects of herbal remedies

Evidence-Based Herbal Drug Toxicity

Evidence-Based Drug Herbal Interactions

Findings

The Way Forward For Developing Countries