Herbal medicines are used by about a quarter of adults in the UK, the market is worth at least £485m, and they have a powerful advocate in Prince Charles. In one of his recently published “black spider” letters, sent to Tony Blair in 2005, the Prince urged a delay implementing EU restrictions on herbal medicines: “I think we both agreed this was using a sledgehammer to crack a nut.” But concerns over safety, standardisation, interactions with other drugs, as well as extravagant claims and lack of evidence for efficacy have all led to attempts to regulate herbal medicine and its practitioners.
Edzard Ernst, emeritus professor of complementary medicine at Exeter University, says they should be judged in the same way as conventional ones: “If a therapy demonstrably generates more good than harm, it should be considered for routine use.” The problem is that, without good clinical trials, it is hard to say whether a medicine does work – and trials are expensive, time-consuming and hard to organise, especially for small manufacturers.
Since 2011, products have to be registered with the Medicine and Healthcare Products Regulatory Agency (MHRA) and granted a traditional herbal registration (THR) before going on sale. The MHRA usually requires drugs to be of sufficient quality, safety and effectiveness but, in the case of herbal medicines, it recognised the difficulty in providing evidence of effectiveness and asked only for proof of quality and safety and patient information. Reassuringly, registration means that hundreds of potentially dangerous products have been banned.