Herbal medicine use: Personal and professional opinions on safety and efficacy

This was an attitudinal study on the use of herbal medicines in general.

The aim of this study was to explore UK based healthcare professionals’ (HCP) personal and professional opinions and experiences of using herbal medicines, including aspects of safety and efficacy.

This was an exploratory study using a questionnaire to obtain qualitative and quantitative data. There were four sections:

• Exploring respondents personal use of herbal medicines and knowledge of herbs
• Patient use of herbal medicines
• HCP opinions on using herbal medicines
• Participant demographics

The questionnaire was deployed online using SurveyMonkey®.

Not relevant to this study as it explored the knowledge and attitudes of healthcare professionals’ use of herbal medicines in general.

The study used opportunity sampling via social media and personal connections, and then encouraged participants to forward the survey to colleagues. A total of 93 questionnaires were analysed.

To participate the respondent was required to be a healthcare professionals (HCP) having interactions with patients, including doctors, surgeons, nurses, dentists, pharmacists, optometrists, and physiotherapists, herbal medicine practitioners etc. Participants were required to have experience of working in the UK.

As participants shared their ethnic groups as part of the survey, comparisons could be drawn between groups, which revealed statistically significant differences in herbal medicine use by participants’ families. Respondents were majoritively Asian/British-Indian/Pakistani/Bangladeshi (n=40) or white-British/Irish (n=37).

Twelve were other ethnicities. Participants from the Asian/British-Indian/Pakistani/Bangladeshi group were most likely to say herbal medicine was part of their family and cultural background (n=35 respondents) compared to other groups. White British/ Irish participants (n=38) were more likely to claim that herbs were not part of their traditional heritage.

HCP use of herbal medicines

Around a third of respondents agreed they used herbal medicines themselves (n=42) and in the questionnaire collectively shared 83 different plant species that they had used.

Most commonly, remedies for coughs and colds were mentioned and included:

• Lemon (Citrus limon)
• Turmeric (Curcuma longa)
• Echinacea (Echinacea angustifolia)
• Tulsi (Ocimum tenuiflorum)
• Ginger (Zingiber officinale)

For digestion:

• Cinnamon (Cinnamomum verum)
• Mint (Mentha arvensis)
• Ginger (Zingiber officinale)
• Cardamom (Elettaria cardamomum)
• Cumin (Cuminum cyminum)

Herbs were also mentioned to treat skin conditions, stress, anxiety and sleep.

HCP knowledge and training

Knowledge of herbal medicines was variable according to ethnic background, and those that used them were more likely to recommend them to patients. Some preferred to recommend herbal medicines based on available clinical evidence. Most professionals had received no formal herbal medicine training, and many professionals wished to learn more.

Safety

HCPs were familiar with adverse events and herb-drug interactions associated with some herbal medicines and provided a list of such interactions. However, their knowledge overall was not comprehensive and many were unaware of potential interactions with conventional medicines.  Overall 66% (n=63) of professionals suggested herbs were effective for treating a range of health conditions, and about a half thought they were safe.

The aim of the study was to understand healthcare professionals’ attitudes and knowledge regarding the use of herbal medicines in the UK. Many studies focus on patient perspectives but very few explore the personal relationship with herbs that healthcare professionals have themselves.

Although the survey response was relatively small, the study provides valuable insight into the use, knowledge and recommendations made by professionals in the UK. Differences between ethnic groups also revealed that Asian/British-South Asian participants were more likely to use and recommend herbal medicines than the white British demographic whose knowledge was weaker.

Several participants reported a keenness to recommend herbal medicines, yet  the insufficiency of coverage of herbal medicine in their training left them feeling incompetent to advise their patients.

The historical use of herbal medicine was insubstantial for HCPs to determine that herbal medicines were a worthwhile therapeutic consideration, and responses highlighted that clinical evidence to support the safety and efficacy of herbal medicine would encourage their further learning about herbal medicines and their therapeutic value. Other areas of interest included herb-drug interactions and where best to acquire high quality herbs.

The survey suggests that there are professionals seeking to use complementary and alternative therapies including herbal medicines as they grow their integrative healthcare approaches. Other research has taken a deeper view and suggests that the use of herbal medicine and certain plants are important for community culture and tradition. This study suggests that healthcare professionals were more supportive of the use of herbs where conventional medicines are unsuccessful (2).

Some healthcare professionals are likely to use and recommend the use of herbal medicines to patients, with individuals from Asian/British-South Asian ethnic groups more likely to do so compared to white British participants. Responses highlighted a need to improve professionals’ knowledge on the safety and efficacy of herbal medicines, to establish a basis of understanding and confidence. More research is needed to evaluate the attitudes of different professional groups, and to investigate how to best integrate herbal training within existing educational frameworks.

1. Bhamra, S. K., Slater, A., Howard, C., Heinrich, M., & Johnson, M. R. (2019). Health care professionals’ personal and professional views of herbal medicines in the United Kingdom. Phytotherapy Research, 33(9), 2360-2368. Available: https://discovery.ucl.ac.uk/id/eprint/10079147/1/Heinrich_AAM_Healthcare%20professionals’%20perceptions%20of%20herbal%20medicines%20PTR%20Version%202.pdf
2. Longden-Naufal C, Rolfe V, Mackonochie M. Narratives of Herbal Medicine Utilisation in the United Kingdom: Scoping Literature Review. Front Pharmacol. 2022 Aug 25;13:886574. doi: 10.3389/fphar.2022.886574. PMID: 36091802; PMCID: PMC9452627.