herbal medicines..?

[little one]

I would just like to get some pharmacists' opinions on herbal medicines.
Is a no-go area? Do you think we should be properly trained in them? Should we advise them? Do you think they should be prescribed? What about those people out there that recommend them, but have no training? Are patients just going to use them anyway?
Any thing else you would like to say about them?

[DavidS]

I think we are missing a major trick by not stocking herbal products and medicines. Not a day goes by in a town centre but I'm asked for advice about drug herb interactions, and it turns out the have been sent in by the local health store or more likely H and B for our free advice. I would like to start a system of insisting such patients have an intervention mur, and that we tell them that we will be able to provide their health food needs in future, and check them automatically against their prescribed medicines.

Of course, the range is phenomenal, but H and B seem to be doing OK. If a wholesaler stocked the range and sent them with the medical deliveries, I bet we could capture a lot of this business.

If you left out breakfast cereals, nuts, seeds and jams, etc, it wouldn't take that much space.

[johannes]

I I would like to start a system of insisting such patients have an intervention mur, and that we tell them that we will be able to provide their health food needs in future, and check them automatically against their prescribed medicines.

Brilliant idea, wish that had been implemented years ago here.

[crit care]

Surely an intervention MUR would be creating yet more work....everyone complains about the workload now so add in a herbal medicines one, then can you imagine the complaints.

I'm not a big fan of herbal medicines and if someone asked me to recommend one i'd tell them not to waste their money, but if someone was adamant they wanted to buy some i'd sell it to them, but say its probably not worth the money, and may do very little...but who am i to dictate how a person perceives the advertisements in the windows of other shops! quite passive when it comes to herbal medicines!

[Nik]

I wouldn't totally dismiss herbal medicines - its the homeopathic tat I'm a bit more concerned about.

[crit care]

i think with homeopathic medicines there is very little evidence for any of them, and the evidence which is out there isn't that great!

i wouldn't advocate their use

[johannes]

The question is, in general, how are we reimbursed for qualified advice?
Others sell, we provide, advice for free?
Who pays our rent?

[weeneldo]

I definitely think there are some minor flaws with homeopathy. I mean, for example, for homepathic principles to work, they would have to defy many of the basic laws of physics that apply to everything else in the universe. Things like that tell me it might not be 100% effective.

Don't even get me started on pharmacies selling products like homeopathic anti-malarials and homeopathic anti-epileptics. It really scares me that a pharmacist could have such little grasp on evidence based medicine that they risk killing a patient with sugar pills.

[bolam]

what's your opinion on digoxin then? artemesinin? aspirin? are these also not to be recommended?

[weeneldo]

Well they aren't based on homeopathy. But with regards to herbals (ie. not those developed into a licensed medicinal product):

- We have much less knowledge and experience with them, their side effects, dosages, interactions, indications and contra-indications.
- Much less evidence and guidance exists for us to base our advice upon.
- Information with regards to the above is much less freely available.
- Herbal products have nowhere near the level of regulation that pharmaceutical products do.
- The herbal products that have been shown to effectively work are usually researched, developed, formulated, tested and marketed until they (or the active compound or an analogue) end up as a pharmaceutical formulation, meaning that the licensed medical products available to us are generally based on the best of the herbal products available. This generally makes them more effective than any pure herbal product available.

This means that we are generally better suited to recommend a marketed pharmaceutical formulation in terms of evidence for our advice as well as various aspects of safety and efficacy.

However, I still think that pharmacists should have some knowledge of herbal formulations, so that we are able to advise on any products a patient may already be taking or ask about and if we are to stock these products in our shops we must have a knowledge of them that equals our knowledge of any other OTC product. This includes recongising the limitations and risks of using herbal medicines and advising patients on these when appropriate.