MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

About 85% of German children are treated with herbal remedies. Yet, little is known about the effects of such interventions. A new study might tell us more.

This analysis accessed 2063 datasets from the paediatric population in the PhytoVIS data base, screening for information on indication, gender, treatment, co-medication and tolerability. The results suggest that the majority of patients was treated with herbal medicine for the following conditions:

  • common cold,
  • fever,
  • digestive complaints,
  • skin diseases,
  • sleep disturbances
  • anxiety.

The perceived effect of the therapy was rated in 84% of the patients as very good or good without adverse events.

The authors concluded that the results confirm the good clinical effects and safety of herbal medicinal products in this patient population and show that they are widely used in Germany.

If you are a fan of herbal medicine, you will be jubilant. If, on the other hand, you are a critical thinker or a responsible healthcare professional, you might wonder what this database is, why it was set up and how exactly these findings were produced. Here are some details:

The data were collected by means of a retrospective, anonymous, one-off survey consisting of 20 questions on the user’s experience with herbal remedies. The questions included complaints/ disease, information on drug use, concomitant factors/diseases as well as basic patient data. Trained interviewers performed the interviews in pharmacies and doctor’s offices. Data were collected in the Western Part of Germany between April 2014 and December 2016. The only inclusion criterion was the intake of herbal drugs in the last 8 weeks before the individual interview. The primary endpoint was the effect and tolerability of the products according to the user.

And who participated in this survey? If I understand it correctly, the survey is based on a convenience sample of parents using herbal remedies. This means that those parents who had a positive experience tended to volunteer, while those with a negative experience were absent or tended to refuse. (Thus the survey is not far from the scenario I often use where people in a hamburger restaurant are questioned whether they like hamburgers.)

So, there are two very obvious factors other than the effectiveness of herbal remedies determining the results:

  1. selection bias,
  2. lack of objective outcome measure.

This means that conclusions about the clinical effects of herbal remedies in paediatric patients are quite simply not possible on the basis of this survey. So, why do the authors nevertheless draw such conclusions (without a critical discussion of the limitations of their survey)?

Could it have something to do with the sponsor of the research?

The PhytoVIS study was funded by the Kooperation Phytopharmaka GbR Bonn, Germany.

Or could it have something to do with the affiliations of the paper’s authors:

1 Institute of Pharmacy, University of Leipzig, Brüderstr. 34, 04103, Leipzig, Germny. nieberkaren@gmx.de.

2 Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 573, Bonn, Germany. nieberkaren@gmx.de.

3 Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

4 ClinNovis GmbH, Genter Str. 7, 50672, Cologne, Germany.

5 Bayer Consumer Health, Research & Development, Phytomedicines Supply and Development Center, Steigerwald Arzneimittelwerk GmbH, Havelstr. 5, 64295, Darmstadt, Germany.

6 Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173, Bonn, Germany.

7 Institute of Pharmaceutical Biology, Goethe University Frankfurt, Max-von-Laue-Str. 9, 60438, Frankfurt, Germany.

8 Chair of Naturopathy, University Medicine Rostock, Ernst-Heydemann Str. 6, 18057, Rostock, Germany.

WHAT DO YOU THINK?

4 Responses to ‘Good clinical effects’ of herbal remedies in paediatric patients?

  • OMG! Treating with Herbal remedies and little is known! Be very afraid!

    We’ve probably only been doing it with the knowledge accumulated since proto-humans first climbed down out of the trees (3 or 4 million years ago more or less (??); at least 20,000 times longer than conventional medicine has been around). Lets not get hasty about using these new materials. Better require lots of impossibly expensive studies, and large safety labels before they are marketed. And its good that the FDA keeps any label claims out of the hands of possible mis-users. Dont let any claims be made that could possibly be tested by the simple minded users. I say this situation requires a stronger nanny state, directed at the behest of so-called skeptics who are the only ones intelligent enough to be trusted with this dangerous new technology and the only ones with the best interests of everyone in mind.

    • @Roger

      OMG! Treating with Herbal remedies and little is known! Be very afraid!

      We’ve probably only been doing it with the knowledge accumulated since proto-humans first climbed down out of the trees (3 or 4 million years ago more or less (??); at least 20,000 times longer than conventional medicine has been around).

      Nobody lights up the smile on my face quite as quickly a you do, Roger. And by smile, I mean sardonic laugh, sprinkled with pity.

      The question that immediately comes to the mind of a critical thinker—that would be me, not you—is that if the nonsense you are peddling has been around “at least 20,000 times longer than conventional medicine,” why is it that there is no published evidence of its effectiveness?

      Surely someone, some time and in some place on this great planet of ours thought putting together some real science on these things might just be a good idea. It would almost certainly end the criticism and you would no longer look like the silly fool you want people to think you are.

      Many decent people who believe in these nonsense treatments or treatments that may well work but we don’t know for sure, simply don’t have the facts. I get that. They make decisions without thinking too much.

      Then, there are others who DO have the facts but are so arrogant that they think they know better that all the scientists and researchers in the world. Do I have to actually say in which camp you’ve set up your tent?

      Feeding time is over.

  • Well there is medicine that works and medicine that doesn’t.

    The point of study examined by this article is that it doesn’t demonstrate anything useful about the herbal remedies being used.

  • Surveying mainly people who are still using herbal remedies – everyone who tried them 2 months or more ago and found them worthless is excluded. A great way of getting a meaningless positive result.
    To quote a song, “The regulars can’t keep away from the hard rock cafe” – if they kept away they wouldn’t be regulars.

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