The use of botanicals as foods through to medicines was the focus of a special presentation on the role of botanical supplements in health during the international congress here this week.
  As stressed by Dr. Albert Leung, Glen Rock, New Jersey, U.S.A., a distinction needs to be made between herbs used for treating diseases and those used for disease prevention and health maintenance. “The former are plant extracts which are not meant for long-term use, but rather they are prescribed for specific therapeutic purposes and they are not to be confused with the latter which are the tonics in traditional Chinese medicine and which are used to promote good health,” he told delegates. Unfortunately, this distinction is blurred in the United States where the same botanicals considered and used as medicines in Europe and elsewhere are considered dietary supplements and as such, can be sold by anyone.
  This situation is potentially dangerous, speakers agreed, because in the absence of credible scientific information, people tend to believe what they are told about botanicals, and the health claims made about them often have little basis in fact. To correct this, Dr. Leung stressed that credible information based on science must be brought to bear to the whole field of botanicals.
  Efforts are now being made by the Chinese University of Hong Kong to develop a data base where good information on plant-derived medicine will be translated into English and made available to a broader base of practitioners. Knowledgeable scientists are currently developing authoritative monographs on botanical medicines both in Europe and in the U.S, the latter initiative being done by an educational foundation with a view to putting together an American Herbal Pharmacopoeia. Again, these extensively researched peer-reviewed monographs developed by medical plant experts will serve as a credible information base.

Botanical use in most of Europe is clearly better controlled than it is in the U.S., as was made clear by Dr. Joerg Gruenwald, Director, Institute for Phytopharmaceuticals, Berlin, Germany. “Herbs have been around since the beginning of mankind and, in fact, the development of modern pharmaceuticals comes from herbs. So for most of Europe, botanicals are considered as medicines,” he noted. In North America, certain botanicals with specific therapeutic value are placed in the same class as other botanicals which merely promote general good health, for example dietary supplements.
 Furthermore, in order to gain their status as drugs, botanicals must be supported by scientific evidence of efficacy, safety and consistency of product and approved by regulatory authorities before they are registered. Once registered, botanicals are widely prescribed by physicians who have received some training in the use of herbs during medical school, and some of whom have specialized in natural therapies and who are considered experts in the field of phytopharmaceuticals, at least in Germany. Indeed, up to 50% of doctors in Germany prescribe, and are reimbursed for, botanicals as part of their routine practice, Dr. Gruenwald noted.

Germany is a prime example of the successful integration of phytomedicines into mainstream medicine. The inclusion of training on phytomedicines in the German medical curriculum could serve as a model for North American medical schools.
 As an example, Dr. Gruenwald discussed the recent “star” of the botanicals, hypericum, or Saint Johns wort. “Right now, hypericum is the leading antidepressant prescribed in our country,” he said. This might be somewhat unique, he added, but it only came about because the science on hypericum as an antidepressant is solid and well-known to practitioners outside of North America. Other botanicals including garlic, ginkgo-biloba, valerian, ginseng and hawthorn ginger, have similarly been subjected to vigorous, well-controlled studies and have good science behind their use.
 Echinacea has achieved a similar sort of “star” status in North America, where it is widely felt to strengthen the immune system and help prevent infection, especially colds and the flu. Researchers at the Center for Biochemistry of Frankfurt University have shown that echinacea stimulates interferon production, thus giving it general anti-viral and anti-bacterial effects.
 And while many botanicals have not been subjected to such rigorous scrutiny, Europe is now trying to bring more science to the practice of phytomedicine with the development of authoritative monographs-five of which have already been approved by the European Union, and details of which were discussed by Dr. Bettina Soeholm, who represents Denmark on the European Scientific Cooperative on Phytotherapy.
 These monographs will also help harmonize the use of botanicals as either dietary supplements, OTC products or prescription medicines throughout Europe, said Dr. Gruenwald. “There are diseases and acute situations where you are not going to treat the patient with botanicals, but we are getting older as a population and there are many situations where we can improve the life quality by using these natural products and they have been tested, they do work, so why not use them,” said Dr. Gruenwald, adding, “and for those patients who have had a bad experience or a lot of side effects with chemical drugs, these botanicals represent a viable option.”

Dr. Bernadette Marriott, of the U.S. Office of Dietary Supplements, National Institutes of Health, in turn detailed the activities relating to research into the whole field of botanical supplements at the NIH. In her view, among others, issues surrounding the efficacy and, most critically, the safety of botanicals must be given careful scientific attention, especially given the unrestricted and sometimes ill-advised use of botanicals in the U.S. To this end, the NIH has launched what will be the first study of its kind done in the U.S., in which hypericum will be evaluated against the selective reuptake inhibitor (SSRI), sertraline, and placebo for the treatment of major depression. The three-arm trial will involve 112 subjects, and will be conducted over a period of eight weeks, followed by a fourmonth observational period. “This is the first study of its kind with a botanical supplement but we intend to do other clinical trials with other botanicals in the same tradition of using a randomized, double-blind, placebo-controlled protocol to carefully evaluate these products,” she noted.
Dr. Maurice Iwu, Walter Reed Army Medical Center, Silver Spring, was also on hand to put into perspective the use of dietary plants and medicines in traditional health care in Africa. “It’s important to appreciate that plants can be used in a variety of ways, and that the same plant, processed differently, may be a food or a drug,” he noted. Further, phytomedicines can be harmful when inappropriately used and their potential toxicity must be both recognized and respected.
However, as Dr. Iwu pointed out, botanicals are amenable to Western scientific standardization and study, and efforts are now being made to test various plants for specific properties against both common and uncommon pathologies.
“Sometimes, it’s not worth the pharmaceutical industry’s while to develop drugs for diseases that are uncommon,” he suggested. For example, studies of a certain plant now under development show excellent activity against Leishamanisis, an uncommon disorder for which there is no known cure. Hence, the development of a phytomedicine which would be effective against Leishamanisis would prove of value.