Walk down the "medicine" aisle of any supermarket these days and you will discover a "jungle" of plant-derived remedies or "herbal medicines." Such exotic substances as echinacea, saw palmetto, gingko, ginseng, and St. John's Wort casually sit next to the various aspirin, acetaminophen, and antihistamine preparations. Herbal substances are also marketed as beneficial additives in cosmetics, teas, and other food products. Most people know very little about the "medicinal" properties of plants or herbs and yet the popularity and sales of these products are soaring. The total sales of herbal preparations were $655 million in 1994 and are expected to reach $1.6 billion by the year 2001 (Gori & Campbell, 1998).
The prevalence of herbal substance use in the general population is estimated at 3%. This is probably a low estimate. Among patients with certain conditions such as AIDS, asthma, arthritis, cancer, anxiety, depression, infertility, premenstrual syndrome, and diabetes the prevalence of herbal use appears to be much higher (Beal, 1998; Blanc, Kuschner, Katz, Smith, & Yelin, 1997; Borins, 1998; Campion, 1993; Coppes, Anderson, Egeler, & Wolff, 1998; DiPaola et al., 1998; Eisenberg et al., 1993). Herbal medicine is probably the most commonly used alternative medical therapy (Brody, 1998; Eisenberg, 1997). There are more than 20,000 products commercially available which are commonly described as "natural" remedies (Gori & Campbell, 1998; Palmer, 1998; Vann, 1998). This number includes a vast array of herbs and products such as algae, shark cartilage, chromium, zinc, hormones such as DHEA, and "ancient" Chinese compounds. Most of these "natural" substances are sold as tablets, teas, or liquids which can improve "well-being."
It is well known that many of our modern drugs are derived from plants. From the early centuries, therapeutic effects of certain plants were evident. In some ancient cultures, specific plants were considered to have "magical healing powers." Digitalis, atropine, senna, and narcotics are notable examples of medications used today that originated in plant form. The pharmacologic properties of conventional medicines derived from plants began with anecdotal evidence. Trial and error methods used in the past resulted in a customary use of certain plant-derived medicines. However, over the years randomized, controlled clinical trials have repeatedly tested the efficacy, dose effects, and side effects of "conventional" plant-derived medications. Clinical investigators have performed a multitude of studies involving such drugs as digitalis, reserpine, morphine -- all plant-derived agents. With these scientific investigations came an increasing knowledge base regarding indications and drawbacks of these drugs.
Very few of the "herbal remedies" which are commercially available have been subjected to such stringent clinical scrutiny. Most herbal substances have insufficient objective data substantiating health claims. Research studies and clinical use of herbal substances are more common in Europe than in the United States. German investigations of the medicinal value of herbs are particularly prominent in the literature. According to Winslow (1998), results of European studies cannot be used to legitimize use of herbal remedies in the United States. European countries have better regulation over the industry and standardized herbal products are available. In the United States, currently there is a lack of similar regulation and standards and a wide array of variation exists among herbal products. This leaves consumers with unanswered questions about efficacy, safety, and quality of the various available products.
Regardless of the unanswered questions, herbal medicine is said to exist within an "invisible mainstream" in the American health care system (Eisenberg, 1997). This increasing trend deserves the attention of all health care providers since it affects patient health care.
Why the Surge in Use of Herbs?
The literature offers several explanations for the surge in the use of herbal remedies among consumers. According to Vann (1998), there is a pervading sense of skepticism about modern medicine within society. Some people believe that conventional medicines are "unnatural" substances. People have a sense that "natural" substances help the body build on its own resistance. Also, many people are seeking comfort and control for chronic conditions which presently have no medical cure. Many of these individuals often use herbal remedies in addition to conventional medical therapies. Twenty-eight percent of 1,500 people surveyed in 1990 used both conventional and "unconventional" treatment methods for the same disorder. Significantly, 72% of these individuals did not tell their physician about using "unconventional" treatment (Campion, 1993). According to Angell and Kassirer (1998), part of the public's interest in herbal medicine stems from disillusionment with the impersonal care often delivered by conventional medicine. Also, at times, conventional medicine requires harsh treatments for life-threatening diseases. Many patients fear the distressing side effects of some conventional medication regimens and seek alternatives. Certain treatment modalities such as cancer chemotherapy are widely perceived by the public as unpleasant experiences. Often patients feel a loss of control when undergoing certain medical treatments for serious illnesses. Herbal medicine, lifestyle changes, and diet regimens often give patients a sense of control over …
