Analysis of Chinese herbal creams prescribed for dermatological conditions
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7183.563 (Published 27 February 1999) Cite this as: BMJ 1999;318:563All rapid responses
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I wonder how you justified publishing the same article in
BMJ and also in the May 1999 issue of WJM (Western Journal
of Medicine? I thought everyone know this was strictly
forebade by all journals? Please respond to the readership
of both journals. (I have no competing interests.)
Competing interests: No competing interests
EDITOR, Keane et al reported the analysis of Chinese herbal creams
prescibed for dermatological conditions and the finding that many contain
dexamethasone at concentrations inappropriate for their site of use. All
patients treated with these creams were unaware of their ingredients.
Keane et al concluded that "greater regulation & restriction needs to
be imposed on herbalists" to prevent illegal and inappropriate
prescribing.
We support Keane et al in their call for greater regulation not only of
alternative practitioners but also of their unlicensed products.
On the 28/7/99 Prof. Breckenridge, Chairman of the Committee on Safety of
Medicines sent an urgent message to medical professionals via the Chief
Medical Officer and the Public Health link / EPINET system (a dedicated
electronic network linking the CMO to Health Authorities, Trusts and
GP's). The message warned medical professionals about renal failure
associated with 'aristolochoia,' found in some Chinese Herbal Medicines.
Recently a patient
was investigated following complaints of fatigue, loss of appetite,
constipation and myalgia. She was found to have severe anaemia caused by
lead poisoning. For several weeks she had been taking various "remedies"
given to her by an Ayurvedic Practitioner. These remedies were analysed at
the Medical Toxicology Unit, Guy's & St. Thomas' Hospital, and two
were found to contain high levels of lead, arsenic and mercury. These were
Mahayograj-Guggul (lead: 28,900ppm; mercury: 4,970ppm) and Pulsineuron
(lead: 10,200ppm; mercury: 5,840ppm; arsenic: 45,900ppm).
The cases documented here raise a number of issues concerning the safety
of alternative medicines.
The use and expenditure on alternative medicine has increased
substantially in the last decade, to an estimated $21.2 billion in the USA
in 1997. The fact that 'traditional' and 'herbal' remedies, particularly
from the Indian subcontinent, can lead to heavy metal poisoning is not
new.
It is worrying that with increasing use of alternative medicines in the
UK, there is no established national mechanism for ensuring the safety of
these products, and also there is no rapid system to warn the public
against taking those remedies identified as dangerous.
Alternative medicines are not licensed, and therefore are not regulated or
tested as stringently as prescribed medicines. The public tend to regard
'traditional' and 'herbal' remedies as safe due to the fact that they are
natural plant-derived products. They pose a threat to health that many
people are unaware of.
Dr Sarah R. Anderson
Specialist Registrar in Public Health
Dr Claude Seng
Consultant in Communicable Disease Control
Brent and Harrow Health Authority, Bessborough Road, Harrow, Middlesex.
HA1 3EX.
1. Keane FM, Munn SE, Du Vivier AWP, Taylor NF, Higgins EM. Analysis
of Chinese herbal creams prescribed for dermatological conditions. BMJ
1999;318:563-4.
2. Breckenridge A. Renal Failure associated with Aristolochia in
some Chinese herbal medicines. CEM/CMO/99/8
3. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay
M, Kessler RC. Trends in alternative medicine use in the United States,
1990-1997: results of a follow-up national survey. JAMA 1998;280(18):1569-
75.
4. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food
supplements. A 5-year toxicological study (1991-1995). Drug Safety
1997;17(5):342-56.
5. Prpic-Majic D, Pizent A, Jurasovic J, Pongracic J, Restek-
Samarzija N. Lead poisoning associated with the use of Ayurvedic metal-
mineral tonics. J Toxicol Clin Toxicol 1996;34(4):417-23.
Competing interests: No competing interests
I question the basic validity of the study as it was done based on
materials brought in by patients. These products could have been
adulterated before the study began.
To me, it would be preferable to purchase the product "off the
shelf".
This is in no way to deny that there can be problems from imported
products; that is always a possibility.
Thankk you.
Competing interests: No competing interests
Doctors in the orient have practiced for thousands of years mixing
their own prescriptions. With the advent of highly refined chemical
medicines and botanical extractions this Chinese practice goes on and one
finds herbal and prescription medicines mixed together in some cases..in
preparations made in the orient or dispensed by one of that culture. The
physician who paints all herbal therapy with a blackened brush and insists
on strict government controls for all such things is simply being
hysterical based on evidence of a discrete situation that does need better
management. Holding all herbal and naturopathic pharmaceuticals to
accurate labeling standards is not only a worthy principle it is an
essential ingredient of medico-legal public policy. Holding learned and
honorable natural methods health care hostage to principles and practices
appropiate to conventional modern medicine is to disenfranchise
fundamental personal authority and rational opportunity for self-care.
Let's correct the inappropiate and work the genuine problem in the size
that it is.
Competing interests: No competing interests
Dear Editor
Keane et al, BMJ 1999, 318; 563 (Analysis of Chinese herbal creams
prescribed for dermatological conditions) have submitted further evidence
that some of the widely-touted so-called 'herbal' and 'natural' products
contain potent prescription-only drugs. This serves to remind us that
although such preparations are often aggressively advertised as harmless
"it is 'natural'/'herbal' so it has no drug
interactions or side effects" ) directly to the unsuspecting patient (and
sometimes sold to them by non-medically qualified practitioners), many of
them are in fact definitely NOT harmless. Many of these preparations do
not
carry adequate labelling of the contents. POM ingredients are included
with no indication of their presence. Interactions are highly likely with
both prescribed medication, and other non-prescribed drugs. Even allergies
occur to such off-label constituents, such as for lactose-intolerant
patients to the lactose in many 'homoeopathic' preparations. Let us not
forget that both
warfarin (clover) and Digoxin (foxglove) are herbal drugs, but both can be
fatal if improperly used. Even aspirin, a completely safe, 'herbal'
variety of which can be obtained from some herbalists (as claimed on TV
this week) is subject to side effects and allergic reactions in
susceptible people. It is about time we as a Profession took
responsibility for ensuring Government applies controls to the production
and distribution of ALL drugs, and stop the loophole that allows
'natural', 'herbal', and 'homoeopathic'
remedies to be marketed with no guarantees of efficacy, safety, stable
dosage, and product quality. After all, it is the health and safety of our
patients that is at risk.
David Church
locum GP
mid-Wales
Competing interests: No competing interests
The problem with redundant publication is failure to disclose it
The problem with redundant publication is not publishing the same
material twice, which happens all the time, but rather doing so without
full disclosure. It is the intent to deceive which is the problem. For
example, the Committee on Publication Ethics report, which was published
earlier this month, defines redundant publication thus: "Redundant
publication occurs when two or more papers, without full cross reference,
share the same hypothesis, data, discussion points, or conclusions." (1)
In other words, publishing material in the WJM that has appeared in the
BMJ is not redundant publication--because it is disclosed.
We have for nearly 20 years taken material that was published in the
BMJ and republished it in our local editions. The Student BMJ contains
material published in the weekly BMJ. Our ABC books, which again go back
20 years, republish material that is published in the BMJ. Our regret is
not that we do this but that we don't do it more. Publishers meet the
needs of different groups and audiences by republishing material. We
sometimes publish material that has appeared in other publications in the
BMJ--usually when we know that very few of our audience will have seen the
material. There is currently little overlap between the readers of the WJM
(most of whom at the moment are in New Mexico) and the readers of the BMJ.
Richard Smith
Editor, BMJ
1 Committee on Publication Ethics. The COPE Report 1999. London: BMJ
Publishing Group, 1999. (www.publicationethics.org.uk)
Competing interests: No competing interests