Western Herbal Medicine and Dermalogical Practice
Alternative therapies are popular; 49% of patients with a skin problem reported using herbal supplements within the past year, and patients with chronic disease (including eczema and psoriasis) are most likely to use herbal medicines. Herbs have beneficial anti-inflammatory, antioxidant, antibacterial, antifungal and antihistaminergic effects. Regulation of herbal therapies is challenging, and the use of remedies is not without risk, thus they should be administered by an experienced professional.
We have been running a herbal medicine clinic alongside our dermatology department since 2000, allowing patients to safely benefit from Western herbal medicine within a hospital setting. Medical herbalists undergo years of rigorous scientific training and are regulated by professional bodies. Once diagnosed by a consultant dermatologist, patients may be referred to the medical herbalist. Medical herbalists prescribe herbs in a number of forms, and take into account all known interactions with other drugs.
We collected data from all patients (new and followup) who attended the herbal medicine clinic during a 99-month period. Patient self-assessment was performed by completion of a symptom or problem-specific profile prior to treatment and at each visit thereafter, using the validated ‘Measure Yourself Medical Outcomes Profile’ (MYMOP). Each patient recorded up to five ‘problems’ (P1 to P5) and four ‘activities’ (A1 to A4) for which they wanted help. Patients were also asked to record an overall ‘wellbeing’ score (W). For a timescale of during the past week, each question is self-rated on a seven-point scale, with 0 being the least severe and 6 being the most severe. MYMOP considers score changes 0.5 to be clinically significant. Responses were analysed using the Wicoxon signed-ranks tests to determine statistical significance.
In total, 348 patients (73% female; age range 10 months to 91 years) used our service during the review period. The median time between condition onset and referral to the clinic was 5 years (range 1 month to 52 years). Patients were most commonly referred because of failure of standard treatment or because of patient preference. The majority (91%) of patients were referred for a single condition, most commonly eczema (17%), alopecia (13%) and acne (11%). Of the 348 patients, 186 returned ≥ 2 MYMOPs; 85% of patients reported problems in addition to those for which they were referred, mainly dermatological (26%) psychological (18%) and gastrointestinal (17%). Between their first and last appointments, patients reported a statistically significant improvement in their top four problems, dermatological or otherwise, as well as their top two activities and general wellbeing (P < 0.05) (Table 1). P5 and A3–A4 received inadequate numbers of responses to analyse.
All problems that patients considered their main concern (P1) achieved a score change of at least 0.5, although numbers were too small to draw meaningful conclusions. The greatest score changes were observed for rosacea, acne, psoriasis and eczema (Table 2), and thus we tentatively conclude that herbal medicine may be most effective in treating inflammatory skin conditions. Our dermatology herbal medicine service has had a demonstrable impact on patient-reported health outcomes. Dermatologists should consider herbal medicine as an option when conventional treatments have failed or patients express an interest in alternative therapy.
The Full text, plus tables and references can be found via this download.
March 5 2017
EHTPA interim response to the Government's response to the Walker Report on the future of Herbal Medicine Practice in the UK.
On 28th February the Government responded to the Walker Report in a ministerial statement in the Commons (repeated in the Lords).
You can read this response and refresh your memory about the Walker Report as well as read the report prepared by the Herbal Medicine Advisory Committee (HMAC) using these links: -
The statement from Nicola Blackwood, Parliamentary Under Sec of State for Health is available at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-02-28/HCWS505
The Walker Report is available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/417768/Report_on_Regulation_of_Herbal_Medicines_and_Practitioners.pdf
The HMAC safety report is available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545681/HMAC_-_HerbalsafetyOctober2014Final.pdf
As you will read, the Government accepts the majority of the Walker Report's recommendations rejecting the second and third recommendations. Rejection of the second recommendation means that the Government will not reclassify herbal medicines as foods.
This is welcome news because the herbs used as foods are not subject to risk benefit assessment and are not permitted to have any adverse effects.
Walker's third recommendation, which called on the Government to consider a system to allow small scale assembly of products off site on a named patient basis, has been rejected.
This is disappointing as it is very difficult for many individual practitioners to service their patients' needs without such third party supply. We will be seeking to discuss this further with the Government.
We will also be seeking to discuss further the Government's recommendation that all herbalists join the Professional Standards Authority. Page 3 of the letter (see http://riverfrontmedia.co.uk/EHTPA/Letter%20from%20members%20of%20the%20Herbal%20Working%20Group%20to%20Minister.docx) from dissenting members of the Department of Health Working Group clearly lays out the drawbacks of this proposed new system of voluntary registration that in no way measures up to the benefits of bone-fide statutory regulation of our sector originally promised in 2011.
The Government makes it clear that there will be a review of the use of potent herbal medicines laid down in Schedule 20 of the Human Medicines Regulations 2012. We will be actively engaged in any such review ensuring that we continue to have the widest possible access to our herbal medicines.
This is a preliminary response to that of the Government on the Walker Report. We will be reporting back the results of further discussion with the Department of Health and the MHRA. We continue to work to achieve the best deal possible for our patients and the future delivery of herbal medicine by practitioners.