Popularity of herbal treatments skyrockets
Educators need to dispel misconceptions
No doubt about it: There’s a growing interest in herbal medicine all across America. USA Today, for example, reported recently that 1998 sales for over-the-counter herbal supplements reached $4.1 billion.
Many of the herbs popular in the United States have been used in Europe for years, so part of their newfound status is the result of dissemination of information, says Debbie Scholtz, PharmD, assistant professor of pharmacy practice at the University of Tennessee Memphis College of Pharmacy in Memphis. "It probably correlates to the growth of the Internet too," she adds.
The increased consumer interest in fitness, health, and prevention also is spurring the interest in herbs, says Shirley Kindrick, PhD, RD, LD, program director for comprehensive weight management at The Ohio State University Medical Center in Columbus. When Kindrick spoke to a senior citizens group on herbal supplements last fall, over 200 people attended.
The public is eager for information, so the time is right for patient education managers to get involved. Herbal experts agree that factual teaching sheets on popular herbs can dispel many of the misconceptions people have about the benefits of these natural supplements. (To learn what information should be included in a teaching sheet, see above.)
People think if a product’s label says "natural," it is safe by definition, says Scholtz. This is obviously fallacious logic. Also, because herbal supplements often are sold in pill form, people think they are regulated. "For a company to manufacture and sell a dietary supplement, they don’t have to prove that it is safe and effective. They don’t even have to prove that one bottle has the same amount of ingredients that the next bottle does," says Scholtz.
A lot of the variation in herbal supplements has to do with the part of the herb that is used — the root, stems, or leaves. Also, the harvesting method, when it was collected, and how the herbal supplement was produced all affect a supplement’s composition. Even the moisture and temperature involved in drying the herb has an effect on its quality, says Jill Ellis, PhD, director of science and quality assurance at the National Nutritional Foods Association (NNFA) in New Port Beach, CA. "Unlike drugs, they are not synthesized single entities that are clear cut. They are more complicated," she explains.
Are your herbs wild or cultivated?
Yet the industry is making efforts to correct the unpredictability that can be found from product to product. In the past, 80% of the herbs were collected in the wild, where there is no control over growing conditions. Currently, only 40% of herbs used in manufacturing are collected in the wild, and the remaining 60% are organically cultivated, says Ellis.
A wealth of scientific information has been collected on many of the herbs popular with consumers today. For example, it is known that the claims for St. John’s Wort are true, explains Ellis. Now the industry must make sure each bottle of this herbal supplement sold is a quality product, she adds. (For list of the most popular herbal supplements, see table at right.)
To help in this area, the NNFA is implementing a good manufacturing practices program this year. Companies that pass a third-party certification audit will be given a NNFA logo to use on their labels, in their literature, and in ads so consumers will know the product was manufactured in a good manner. Because negotiations are still ongoing, the name of the auditing company cannot be disclosed, says Ellis.
An auditing firm will audit a facility to determine if the producer has good manufacturing practices, identifies the raw product, tests the product at the end of the manufacturing process, knows what is in the product before it leaves the door, has the ability to handle consumer complaints, and provides a sanitary workplace and production line, says Ellis.
Time is ripe for involvement
A second quality assurance program at NNFA is called TruLabel. This program tests the products of its supplier members to verify label claims. "We just finished St. John’s Wort and published the results. So for that point in time, the batch that we tested from a particular manufacturer has to be 100% of the label claim. For example, if the claim is 300 milligrams of St. John’s Wort, then each capsule must have that amount," explains Ellis. Sixteen product lines will be reviewed this year. (Published results can be found on the association’s Web site at http://www.nnfa.org. For other herbal resources, see list on p. 29.)
While consumers must learn to select a quality product, that’s not the only information they need. They need to be sure the herb they select fits their diagnosis. That means getting the right diagnosis before starting a regimen of self-treating. For example, saw palmetto is an herb frequently used to treat prostate disease, but it can mask prostate cancer, says Kindrick.
Ellis agrees. "It is a good idea for consumers to talk to their health care practitioner prior to taking any herbal supplement," she says.
Sources
For more information on herbal supplements, contact:
• Jill Ellis, PhD, Director of Science and Quality Assurance, National Nutritional Foods Association, 3931 MacArthur Blvd., Suite 101, New Port Beach, CA 92660. Telephone: (949) 622-6272, ext. 229. Fax: (949) 622-6266. E-mail: [email protected].
• Shirley Kindrick, PhD, RD, LD, Program Director Comprehensive Weight Management, The Ohio State University Medical Center, 2050 Kenny Road, Suite 1010, Columbus, OH 43221. Telephone: (614) 293-2819. Fax: (614) 293-2801. E-mail: [email protected].
• Debbie Scholtz, PharmD, Assistant Professor of Pharmacy Practice, University of Tennessee-Memphis College of Pharmacy, 3 North Dunlap, Memphis, TN 38163. Telephone: (901) 761-2997. Fax: (901) 763-3649. E-mail: [email protected].
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