Efficacy and safety of herbal medicines
Thailand has a rich history of traditional medicine and healers prescribing herbal preparations which is still practiced today. Like traditional Chinese and Ayurveda medicine, these healers apply holistic medicine as written in abundant ancient scripts describing the formulations, the conditions for which they are prescribed and adverse reactions. The Thai government is promoting their use and commercial exploitation and aims to incorporate traditional medicine into the national health-care system. Nevertheless, many clinicians who ultimately carry responsibility for their patents are skeptical about their efficacy and safety.
Systematic review of studies on Thai traditional medicines: Herbal research in Thailand has focused on several traditional medicines and we have conducted systematic reviews including on Pueraria mirifica, Centilla asiatica as cosmetics , Ya-Hom, mitragynine, Bacopa monneria, ..etc. All studies suffered various degrees of weaknesses in protocol design, conduct, and analyses as judged Cochrane risk of bias, unclear composition of the medicine, and lacking safety information. Numerous Cochrane reviews on global herbal medicines show trials on herbal medicines reach similar conclusions and not confined to products we reviewed. Thus is became apparent that classical clinical trial protocols are inefficient ways of answering key questions about herbals as medicines. Furthermore, the government Department of Traditional Medicine voiced disquiet about the high cost of clinical trials. Yet their intention is to promote Thai traditional medicines as a major export earner.
We have obtained major funding for a study on traditional and herbal medicines in Thailand that includes creating an internet resource for users of herbal medicines. This project comprises several stages:
(i) Surveying the needs and expectations of consumers: Opinions and experiences of users, community leaders, and health workers in rural eastern Thailand were sought during 2018-19. Information learned from this cohort was that: (a) they recognise the safety issues of herbals that can be serious, (b) acceptable side effects are used as guide to their function, (c) herbal medicines are usually sourced locally, are unbranded, unlabelled crude preparations from local markets or door-to-door sales, but not expensive, standardised, blister packaged, nor branded, (d) the information about HMs they needed most was dosing information. Their view about safety seems different to the western perception that herbals, being natural, are safe. A video in which consumers voiced their opinions about herbal medicines is founded here https://www.youtube.com/watch?v=t-Dh8J9ZrXo&t=1s.
(ii) The web-based data-entry portal: Our consumers were less interested in a PV site of which there are now 3 in Thailand, but a complete information source about HMs. In the context of very little knowledge about what herbals are being used, in what form, how they are used, what for, and the amount of relief obtained, PV information alone is superfluous.
Our philosophy for the herbal medicines portal and data base is that consumers feel they are part of community-wide resources and share its ownership. Clearly, inputting data needs feedback in three forms (i) a simple text message, (ii) a telephone call from an expert seeking further information, (iii) on-line database query about other users’ experiences of the same medicine, or about other medicines.
Smart phones are almost universally available to consumers and nearly all areas have 3G coverage and most have 4G. Web pages for smart phones are highly amenable for inputting simple data, while descriptions of symptoms requires more complex dialogue. So a balance between gleaning enough information to be useful and asking for too much causing the user to give up is a major problem.
Many potential users aged >40 have very low educational attainment. This makes it problematic in deciding the range of information sought, the way questions are framed, and the method of data entry. To begin with, we are questionnairing experts in PV and herbal medicines to gain a consensus about essential information.