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Where is the herbal evidence?

  • Simon Mills
    Simon Mills

    I am a Cambridge medical sciences graduate and have been a herbal practitioner in Exeter since 1977. In that time I have led the main professional and trade organizations for herbal medicine in the UK and served on Government and House of Lords committees. I have written standard textbooks used by herbal practitioners around the world, including with Professor Kerry Bone from Australia.

    I was involved in academic work for many years, co-founding the University of Exeter pioneering Centre for Complementary Health Studies in 1987 (where we built a complementary research and postgraduate teaching programme from scratch), then at Peninsula the first integrated health course at a UK medical school, and the first Masters degree in herbal medicine in the USA, at the Maryland University of Integrative Health.

    I am particularly fascinated by the insights we can distill from the millions of intelligent people who over many centuries needed plants to survive. Mostly I want to learn and share the old skills, to experience healing plants as characters, that can help us fend off ill health. My passion for offering people tools to look after themselves and their families has led me to work with the founders of the College of Medicine on pioneering national self care and social prescribing projects. I am now the College Self Care Lead and also Herbal Strategist at Pukka Herbs.

    Listen to our Herbcast podcast with Simon Mills as the host.

  • 16:37 reading time (ish)
  • Research Western herbal medicine

Many say that herbal remedies have not met certain standards. We address that charge and argue for more herbal evidence.

Modern expectations for medicines are that they should have been thoroughly tested to make sure that they work and are safe. Doctors and health regulators use the term ‘evidence-based medicine’ (EBM) as their default for approving treatments. Although this principle does not always apply in medical practice, many say that herbal remedies have not met these standards and should not be recommended. Here we will address that charge and argue that the appropriate use of herbs is fully justified.

Clinical trials

Where is the herbal evidence?

The ‘gold standard’ measure of efficacy is the randomised double-blind controlled clinical trial (RCT). The remedy to be tested is given to a population of subjects on the same basis as a placebo or comparison medicine in a way that neither the subjects nor the investigators know who is getting which. This is intended to reduce conscious and unconscious bias, and by careful matching of each comparison group, and choosing a large enough population, to eliminate other factors such as natural improvements in the condition, suggestion and expectations, that may affect outcome.

There are many arguments about the reliability of the RCT to all circumstances and conditions. It does not reflect individual experiences of illness, is less useful in complex, rare and long-term conditions and blinding is often hard to assure. ‘Publication bias’ results when authors and sponsors hold back on results that do not reflect their expectations and tends to skew reports towards those that are positive. RCTs are very demanding and methodological rigour is also not assured. Nevertheless there is no substitute for a good RCT if we want to get some measure of the independent activity of a remedy.

RCTs require complex organisational capacity, specialist statistical and other skills, are subject to intensive ethical scrutiny, and therefore are notoriously expensive. However there are increasing numbers of such studies being published for herbs.

There is no doubt however that the RCT inventory for herbs is patchy and usually not conclusive. The best way to consider the evidence base is to link it to the most substantial resource we do have: the many centuries of human experience.

Simon Mills

I am a Cambridge medical sciences graduate and have been a herbal practitioner in Exeter since 1977. In that time I have led the main professional and trade organizations for herbal medicine in the... Read more

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