Are Doctors Knowledgeable About Herbal Medicines?

by Stephanie Brunner (B.A.)

A survey of Drug and Therapeutic Bulletin (DTB) subscribers indicates that doctors are poorly informed. In addition, they think their patients know little on the subject of herbal medicines.

The DTB survey on herbal medicines was carried out online in January 2010, by emailing a random sample of 1,157 DTB subscribers. The response rate was just over 14 percent.

More than 80 percent of respondents to the survey were doctors. Most of them were family doctors. Pharmacists made up the bulk of the remainder.

The findings illustrate that more than seven out of ten respondents believe that the public has misplaced confidence in the power of herbal medicines.

Additionally, more than 85 percent think that the public is "poorly informed" on the subject. Not one single respondent considered the public to be well informed.

On the other hand, healthcare professionals rated themselves slightly better. When asked how well informed doctors are on the subject:

• three out of four respondents said they were "poorly informed"
• one in five (21.5 percent) thought doctors were "moderately well informed"
• about half of respondents (48 percent) described their current knowledge and understanding of herbal medicines as either "quite poor" or "very poor"

In addition, nine out of ten admitted that their knowledge of herbal medicines was "much poorer" than their knowledge of prescription medicines.

More importantly, not more than seven out of ten respondents said that if they knew a patient was taking herbal medicine about which they knew little, they would seek additional information before starting or adjusting prescription drugs.

Generally, the greatest reason for doing so (almost 96 percent) was because of concerns over potential interactions between the two forms of treatment. Two thirds (just under 69 percent) worried they might ignore a side effect if they were not well informed.

Among the reasons offered by the three out of ten respondents who said they would not seek further information were:

• uncertainty as to where to find reliable information (60 percent)
• doubt on how to assess and use it (43 percent)

A considerable proportion of respondents (77 percent) worried that their patients would take herbal medicines without telling them. However, despite these concerns, few doctors actually asked their patients about it.

When reviewing or planning prescription drug treatment, only one in eight (13 percent) "always" asked their patient if s/he was taking herbal medicines. More than half (55 percent) either "never" asked or did so only "occasionally."

Also, knowledge of the regulatory arrangements for herbal medicines was poor.

No more than 3 percent of respondents said they knew "a great deal" about this area. However, almost 85 percent considered that herbal medicines are not well regulated.

Dr Ike Iheanacho, DTB editor, commented on the findings: "It's obviously worrying that doctors in general seem to know so little about herbal medicines, given the widespread use of such products."

In 2008, an Ipsos-MORI survey carried out for the drugs regulator the Medicines and Healthcare products Regulatory Agency (MHRA) revealed that more than one in three people surveyed (35 percent) had used a herbal medicine. Also, one in four (26 percent) had used one within the past two years.

He added: "The fact that few doctors make a point of asking patients whether they are taking herbal medicines raises further safety concerns." He comments: "Similarly unsettling is that even when doctors don't know the effects of a herbal medicine a patient is taking, many won't try and look these up."

Michael McIntyre chairs the European Herbal Practitioners Association and is a member of the UK Department of Health Herbal Medicine Regulatory Working Group. In an accompanying DTB podcast, he exposed doctors' belief that familiarization with herbs is somehow a retrogressive step.

He explains that before the beginning of modern medicine, ailments were often treated with herbs, suggesting that doctors feared being "pulled back into the swamp."

In the podcast, Dr Linda Anderson, Principal Pharmaceutical Assessor at the MHRA commented that the Agency's research indicated that patients were ready to tell their doctors if they were taking herbal medicines. Also, they expected them to be knowledgeable about these products.