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The 4th International Congress on Phytotherapy 10–13 September, 1992 Munich, Germany
The 4th International Congress on Phytotherapy 10-13 September, 1992 Munich, Germany
S.Y. MILLS
Centre for Complementary Health Studies, University of Exeter, Exeter, UK
In a recent article on the herbal remedy Ginkgo bilobu in the Lancer,’ the authors made what to most readers would be a surprisingstatement. In Germany and Franceextracts of this plant ‘are among the most commonly prescribed drugs’. (In fact this is an inaccuracy: in Germany Ginkgo is the most commonly prescribed drug.) The authors also put a figure on the cost to the Government and insurers in Germany of prescriptions of this herb - DM 286 million in 1989! It has been calculated that the total cost of prescriptions with natural medicines in Germany is around US$1.7 billion per annum at about 10%of the total pharmaceutical market, and incidentally about 65-70% of the total natural medicine market in Western Europe. It is not surprising that with such commercial activity there is also a significantmedical and academicunderpinning. Them is a proliferation of senior medical academics who publish papers in the field of herbal medicine (phytotherapy) and a number of specialist journals. Companies seeking medicine licences for their products also sponsor considerableresearch activitiesincluding clinical trials. The German Government has for a long time subscribed to the principle of 7’herupieneutrulitdtin which it formally abstains from a preference for any one mode of therapy. Thus when it came to set up the regulatory
framework for its 1976 Drug Law (equivalent to the British Medicines Act), it appointed a special committee, the KommissionE, to review herbal drugs (note: the word drug or Droge referred originally to a dried herb). This was made up of informed experts from the industry and academia and has inter alia drawn up detailed official Governmentmonographs on around 250 herbs. These brief points will help in considering the latest German conference on herbal medicines. This was not a modest affair. Nor, as the conference title suggests, was it just for Germans. The organisers,linked to the German Geselbchafl fir Phytotherapie, formally involved the wider European association of phytotherapists, the European Scientific Co-operative on Phytotherapy (ESCOP). It was as an ESCOP speaker that this reviewer attended. Around 500 scientists, doctors and corporate research directors from all over the world attended 3.5 days of presentations which included almost 100 lectures and the same number of poster presentations,almost all produced in English, which, astonishingly, was the language of the conference. A textbook of abstracts was produced in advance covering all the presentations as well as full glossy programme brochures and other souvenirs not usuallyassociatedwith complementarymedical conferences. Three lecture rooms were used simultaneously and the large site, the Institute of Pharmaceutical Biology at the University of Munich, was a kaleidoscope of stands and displays. The total conference fee was DM 350. Most of the papers presented were either pharmacological or clinical, with some analytical research. As an example Ginkgo had 2 hours in one lecture theatre, with
S.Y. Mills MA, MNIMH, Co-Director. Centre for Complementary Health Studies, University of Exeter, Streatham Court, Rennes Drive, Exeter EX4 4PU. UK.
105
106 ComplementaryTherapiesin Medicine : Cmfemce
section
the following titles: +
Biological standardizationof Ginkgoextracts.
+
Neuroprotective effect of Bifobufide.
+
Potentiation of pharmacological activity of Bilobulideby unknown constituents of a standard&d extract of Ginkgo biloba leaves.
+
Ginkgo biloba for cerebral insuftlciency.
+
Objectifying the nootropic effect of Ginkgo bilobu extract with modem psychometric methods.
+
Results from recent clinical trials with a Ginkgo bilobu special extract.
In the previous session of an hour and a half, under the general title ‘Drugs acting on the cardiovascularsystem’, there were 4 papers: +
Anti-arrhythmic effects of diets rich in polyunsaturated fatty acids or garlic.
+
Increase in heart rate variation in geriatric patients receiving Crataegusoxyacantha.
+
The involvement of a Ca++channel blocking mode of action in pharmacology of medicinal plants exemplified by Ammi visnaguconstituents.
+
Complementary treatment for varicose veins - a randomized, placebo controlled double blind study.
Garlic also had a further two complete sessionsto itself, reflecting no doubt its own role as one of the most widely prescribed drugs in Germany, and there was a whole session devoted to mistletoe. There were also sessionson immunomodulatory, anti-inflammatory, anti-infective, anti-asthmatic, secretolytic, anti-depressant and anxiolytic drugs, and drugs for gastro-intestinaldisorders, sinusitis, bronchitis and for topical application. Faced with such a bewildering diversity of research work the reviewer was pleasantly reassured that this subject, so widely discounted by medical science in the UK, could attract such scrutiny. The next and obvious re-
sponse was to enquire as to the quality of the material presented, although without seeing the complete reports in most cases this was difficult. Least likely to be convincing of course were the presentations of evidence for branded products, making up around a third of the lecture presentations and most of the clinical trials. On the other hand, these were trials conducted for submission to licencing authorities who could be relied upon to scmtinise the evidence closely. They were not all bad. There was, however, overall, a disappointing absence of any negative fmdings, a bias which plagues, and effectively diminishes, the conventional medical literature. Some of the positive findings presented were surprising,involving low doses and multiingredient preparations that were not accompanied by a good pharmacologicalrationale. Clear definition of terms was also often absent. In particular there were cases in which questions of dilution and potency emerged without being addressed; some clinical syndromes and outcome measures were also vague, highlighting a suspicion that ‘Mitteleuropean’science is generally soft on these matters. It was also depressing to be reminded that aversion to animal experimentation is rarely encountered in Europe, although regulatory pressures continue to demand such research. On the other hand there were some good papers as well. The topical effect of Melissaoj%inalis on herpes simplex, reinforcement of the effects of garlic on cardiovascular conditions, and a report on the Chinese herbs for eczema project by the London team were welcome reports of simple clinical studies properly conducted. Some of the many review papers also made interesting listening, and copious notes were taken. Overall, the impression was of material rather like that in most medical conferences: a few gems, much of interest, and a good deal of wishful thinking. For those starved of any academic context in which to study this fascinating field however, it was a tonic. Incidentally, for all those readers wondering what is it that makes Ginkgo the most widely prescribed drug in Germany, the answer lies in old age! It is prescribed as a cerebralvasodilator,popularly associatedwith improving memory and other fading mental functions. As the Lancet article points out there are indeed some positive research findings on the remedy though these am not yet detinitive.’ In the meantime it seems that almost every family doctor in Germany seems to be prescribing Ginkgo to almost every one of their pensioner patients, as they swear by it! QED.
Reference 1. KleijnenJ. KnipxchildP. Ginkgo bildm. Lancet1992 34O(ii): 1136-1139.
S.Y. MILLS
Centre for Complementary Health Studies, University of Exeter, Exeter, UK
In a recent article on the herbal remedy Ginkgo bilobu in the Lancer,’ the authors made what to most readers would be a surprisingstatement. In Germany and Franceextracts of this plant ‘are among the most commonly prescribed drugs’. (In fact this is an inaccuracy: in Germany Ginkgo is the most commonly prescribed drug.) The authors also put a figure on the cost to the Government and insurers in Germany of prescriptions of this herb - DM 286 million in 1989! It has been calculated that the total cost of prescriptions with natural medicines in Germany is around US$1.7 billion per annum at about 10%of the total pharmaceutical market, and incidentally about 65-70% of the total natural medicine market in Western Europe. It is not surprising that with such commercial activity there is also a significantmedical and academicunderpinning. Them is a proliferation of senior medical academics who publish papers in the field of herbal medicine (phytotherapy) and a number of specialist journals. Companies seeking medicine licences for their products also sponsor considerableresearch activitiesincluding clinical trials. The German Government has for a long time subscribed to the principle of 7’herupieneutrulitdtin which it formally abstains from a preference for any one mode of therapy. Thus when it came to set up the regulatory
framework for its 1976 Drug Law (equivalent to the British Medicines Act), it appointed a special committee, the KommissionE, to review herbal drugs (note: the word drug or Droge referred originally to a dried herb). This was made up of informed experts from the industry and academia and has inter alia drawn up detailed official Governmentmonographs on around 250 herbs. These brief points will help in considering the latest German conference on herbal medicines. This was not a modest affair. Nor, as the conference title suggests, was it just for Germans. The organisers,linked to the German Geselbchafl fir Phytotherapie, formally involved the wider European association of phytotherapists, the European Scientific Co-operative on Phytotherapy (ESCOP). It was as an ESCOP speaker that this reviewer attended. Around 500 scientists, doctors and corporate research directors from all over the world attended 3.5 days of presentations which included almost 100 lectures and the same number of poster presentations,almost all produced in English, which, astonishingly, was the language of the conference. A textbook of abstracts was produced in advance covering all the presentations as well as full glossy programme brochures and other souvenirs not usuallyassociatedwith complementarymedical conferences. Three lecture rooms were used simultaneously and the large site, the Institute of Pharmaceutical Biology at the University of Munich, was a kaleidoscope of stands and displays. The total conference fee was DM 350. Most of the papers presented were either pharmacological or clinical, with some analytical research. As an example Ginkgo had 2 hours in one lecture theatre, with
S.Y. Mills MA, MNIMH, Co-Director. Centre for Complementary Health Studies, University of Exeter, Streatham Court, Rennes Drive, Exeter EX4 4PU. UK.
105
106 ComplementaryTherapiesin Medicine : Cmfemce
section
the following titles: +
Biological standardizationof Ginkgoextracts.
+
Neuroprotective effect of Bifobufide.
+
Potentiation of pharmacological activity of Bilobulideby unknown constituents of a standard&d extract of Ginkgo biloba leaves.
+
Ginkgo biloba for cerebral insuftlciency.
+
Objectifying the nootropic effect of Ginkgo bilobu extract with modem psychometric methods.
+
Results from recent clinical trials with a Ginkgo bilobu special extract.
In the previous session of an hour and a half, under the general title ‘Drugs acting on the cardiovascularsystem’, there were 4 papers: +
Anti-arrhythmic effects of diets rich in polyunsaturated fatty acids or garlic.
+
Increase in heart rate variation in geriatric patients receiving Crataegusoxyacantha.
+
The involvement of a Ca++channel blocking mode of action in pharmacology of medicinal plants exemplified by Ammi visnaguconstituents.
+
Complementary treatment for varicose veins - a randomized, placebo controlled double blind study.
Garlic also had a further two complete sessionsto itself, reflecting no doubt its own role as one of the most widely prescribed drugs in Germany, and there was a whole session devoted to mistletoe. There were also sessionson immunomodulatory, anti-inflammatory, anti-infective, anti-asthmatic, secretolytic, anti-depressant and anxiolytic drugs, and drugs for gastro-intestinaldisorders, sinusitis, bronchitis and for topical application. Faced with such a bewildering diversity of research work the reviewer was pleasantly reassured that this subject, so widely discounted by medical science in the UK, could attract such scrutiny. The next and obvious re-
sponse was to enquire as to the quality of the material presented, although without seeing the complete reports in most cases this was difficult. Least likely to be convincing of course were the presentations of evidence for branded products, making up around a third of the lecture presentations and most of the clinical trials. On the other hand, these were trials conducted for submission to licencing authorities who could be relied upon to scmtinise the evidence closely. They were not all bad. There was, however, overall, a disappointing absence of any negative fmdings, a bias which plagues, and effectively diminishes, the conventional medical literature. Some of the positive findings presented were surprising,involving low doses and multiingredient preparations that were not accompanied by a good pharmacologicalrationale. Clear definition of terms was also often absent. In particular there were cases in which questions of dilution and potency emerged without being addressed; some clinical syndromes and outcome measures were also vague, highlighting a suspicion that ‘Mitteleuropean’science is generally soft on these matters. It was also depressing to be reminded that aversion to animal experimentation is rarely encountered in Europe, although regulatory pressures continue to demand such research. On the other hand there were some good papers as well. The topical effect of Melissaoj%inalis on herpes simplex, reinforcement of the effects of garlic on cardiovascular conditions, and a report on the Chinese herbs for eczema project by the London team were welcome reports of simple clinical studies properly conducted. Some of the many review papers also made interesting listening, and copious notes were taken. Overall, the impression was of material rather like that in most medical conferences: a few gems, much of interest, and a good deal of wishful thinking. For those starved of any academic context in which to study this fascinating field however, it was a tonic. Incidentally, for all those readers wondering what is it that makes Ginkgo the most widely prescribed drug in Germany, the answer lies in old age! It is prescribed as a cerebralvasodilator,popularly associatedwith improving memory and other fading mental functions. As the Lancet article points out there are indeed some positive research findings on the remedy though these am not yet detinitive.’ In the meantime it seems that almost every family doctor in Germany seems to be prescribing Ginkgo to almost every one of their pensioner patients, as they swear by it! QED.
Reference 1. KleijnenJ. KnipxchildP. Ginkgo bildm. Lancet1992 34O(ii): 1136-1139.