Intern Emerg Med DOI 10.

1007/s11739-011-0715-3

CE - LETTER TO THE EDITOR

The lack of knowledge about herbal remedies: how could it be improved?

Alessandra Pugi Eugenia Gallo Francesco Lapi Fabio Firenzuoli Alfredo Vannacci

Received: 28 July 2011 / Accepted: 15 October 2011 SIMI 2011

Dear Editor, We read with interest the letter of Dr. Beton et al. [1], and we found several interesting observations. As they stated, herbal remedies (HRs) represent a growing alternative for treating and preventing both chronic and acute diseases. In this context, having standardized approaches and denite rules in manufacturing and controlling these products should be considered pivotal to prevent unpredictable or serious adverse events. In Italy, as well as in most European countries, the procedure for marketing authorization of dietary supplements is based on a simple notication system, with the lack of an exhaustive control on these kinds of products. Moreover, dietary supplement producers may autonomously decide what information (i.e., safety information, contraindications, etc.) should be present on the label and what else should be omitted. As a consequence, some labels may be unclear, incomplete or even omit plants or other xenobiotics. It is instead our opinion that labels should be exhaustively detailed, so as to minimize the risks for consumers health, and to make easier healthcare

A. Pugi E. Gallo F. Lapi A. Vannacci Department of Preclinical and Clinical Pharmacology, Tuscan Regional Centre of Pharmacovigilance, University of Florence, Florence, Italy F. Firenzuoli A. Vannacci Centre for Integrative Medicine, Careggi General Hospital, Florence, Italy A. Vannacci (&) Department of Pharmacology, Center for Integrative Medicine, Center for Molecular Medicine (CIMMBA), University of Florence, Viale Pieraccini 6, 50139 Florence, Italy e-mail: alfredo.vannacci@uni.it

providers work. Hence, quality standards of manufacturing processes and new rules in labeling would be suitable for characterizing bioactive compounds, and promptly identifying all non-declared adulterant agents or contaminants [2]. All these concerns sound relevant given the large availability of marketed HRs. As shown by our survey, almost 20% of patients buy these products on the internet or following friends or acquaintances advices, and some of them still pick herbs on their own, or purchase these products during a journey in foreign countries [3]. Since information provided for HRs and dietary supplements self-administration (e.g., through internet website) is not generally controlled by physicians or pharmacists, the likelihood to retrieve wrong and potentially harmful indications of use is quite high [4]. For this reason, pharmacovigilance and phytovigilance systems are important tools for identifying adverse effects to HRs and potential herb drug interactions, and they also have a demonstrated usefulness in recognizing cases of non-authorized adulterations [5]. Furthermore, since our investigation also reveals a poor knowledge of phytotherapy among healthcare providers [3], university courses on herbal medicine and phytovigilance might be helpful in improving the basic knowledge on efcacy and safety of these remedies among professionals. We strongly believe that the presence of health care practitioners with a basic qualication in herbal medicine favors a more appropriate use of herbal drugs in a national health care system, eventually representing a benet for patients both in terms of efcacy and safety of HRs assumed. In conclusion, even though some HRs are denitely effective in some conditions, and may represent a valuable alternative to traditional drug therapy, nevertheless both a

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high-quality control system before marketing and a better knowledge of their safety prole are mandatory, since the use of HRs is not devoid of risks for the patients.
Conict of interest None.

References
1. Beton O, Mehmet BY, Tandogan (2011) Herbal Remedies: I science or tradition?The Ethical Dilemma. Intern Emerg Med. (Epub ahead of print)

2. van Breemen RB, Fong HH, Farnsworth NR (2008) Ensuring the safety of botanical dietary supplements. Am J Clin Nutr 87(2): 509S513S pii: 87/2/509S 3. Pugi A, Gallo E, Vannacci A, Lapi F, Firenzuoli F (2011) Herbal remedies in hospital setting: an Italian explorative survey among physicians and patients on knowledge and use. Intern Emerg Med. doi:10.1007/s11739-011-0639-y 4. Firenzuoli F, Gori L, Di Simone L, Morsuillo M (2006) Erbe in Internet: informazioni a rischio. Recenti Prog Med 97(4):189192 5. Walji R, Boon H, Barnes J, Austin Z, Welsh S, Baker GR (2010) Consumers of natural health products: natural-born pharmacovigilantes? BMC Complement Altern Med 10:8. doi:10.1186/ 1472-6882-10-8

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