Herbal Medicine Can Help Reduce High Demands on Hospitals

An article in yesterday’s New Zealand Herald , reports that Auckland City Hospital is struggling to cope with a huge increase in demand which has seen almost 200 people coming through the emergency department every day. This increase in patients (7% up on those treated at the same time last year) has also been experienced by a large number of hospitals throughout the country, at a time of year when the impact of seasonal illnesses such as influenza, has yet to manifest.

While New Zealand’s population growth is a contributory factor, A&E departments are seeing a higher proportion of sicker and older people than in the past, as well as chronic illnesses such as diabetes, heart disease and cancer that were less common in days gone by. Additionally, the impact of prolonged poverty and poor diets in too high a proportion of NZ’s population, continues to be avoidable catalysts to a need for emergency hospital services.

The fact that Auckland Hospital’s capacity has been in the high 90’s and has hit 100% a couple of times recently, combined with more and more seriously sick patients requiring treatment, is cause for alarm. Should an influenza epidemic or major disaster occur during the next few months, the ability for existing healthcare services to cope with the sudden increase in additional demand, is in serious doubt. Given the huge and growing pressures they are under, many nurses, doctors, and other healthcare professionals are already close to breaking point, and it is therefore, essential that we reflect upon how this unacceptable situation can be addressed.

Herbal Medicine (Phytotherapy) is the oldest and most used form of medicine in the world. While like most people I am extremely grateful to be living in an age where drugs such as antibiotics and modern medical interventions can treat conditions that once would have resulted in an early death, it is time for the potential contribution of plant-based medicine to human wellness and many common illnesses, to be better recognised.

Evidence for the therapeutic benefits of many herbs and plants incorporated into the diet or an overall treatment approach has increased exponentially in recent years, and to not take this evidence seriously, will be to our peril. A vast body of science suggests that a phenomenal number of plants can either enhance our resistance to and reduce our risks of a wide range of illnesses, or reduce our over-dependence on drug and hospital treatments.

While a large number and diverse array of herbal products are easily obtained from retail outlets or online from e-commerce sites, and many of these are appropriate to take for minor ailments or to help prevent illnesses such as headaches, stomach upsets, colds and the flu, other herbs and a more systematic treatment for more serious or chronic conditions, are best accessed through consulting a properly trained medical herbalist. Such practitioners in New Zealand generally spend 3 or 4 years in full-time training within accredited institutions to study physiology, anatomy, biochemistry, diagnosis and nutrition, and how to prescribe herbal medicines and avoid adverse herb-drug interactions, and most are professional members of the New Zealand Association of Medical Herbalists (NZAMH) . In the same way that we go to a cardiologist for a comprehensive check-up and full diagnosis before being prescribed medications for a heart condition, the professional medical herbalist should be regarded as the specialist we consult before taking herbs for any serious, chronic or debilitating illness.

Apart from their skills in prescribing effective herbal medicines, medical herbalists and naturopaths can make a significant contribution to encouraging healthier diets, lifestyles and other activities that could have a large impact on reducing the number of hospital admissions and pressure on A&E services.

Last week I gave a presentation to a Brisbane conference organised by the Naturopathic and Herbalists’ Association of Australia (NHAA), on the subject of Ginkgo, Ginger and Ginseng, and their use as adjunctive herbs alongside conventional medicine. These are just 3 herbs for which there is compelling evidence that taking them together with various drugs for conditions including dementia, schizophrenia, infectious disease and diabetes, is not only more effective, but can also reduce drug-related adverse effects, and have pharmacoeconomic benefits through reducing the dependence on costly conventional healthcare services. These are just the tip of the iceberg in what else we can achieve through proper and professionally supervised combinations of herbs with drugs, and more research funding and clinical trials are warranted.

As with all health professionals, however, regulation by government to ensure that an adequate standard of service is provided and that the practitioner works in a professional and ethical manner with his or her patient, is essential. The NZAMH is a body that recognised this need a long time ago, and first applied in 2007 for statutory regulation under the Health Practitioners’ Competence Assurance (HPCA) Act (legislation which regulates a number of different health practitioner professions). While this application was subsequently accepted by the then Minister of Health, Pete Hodgson, with a change in government and revision of the HPCA Act soon afterwards, NZAMH was told a new application was needed. A resubmitted application was made to the government in early 2015, but disappointingly, there seems to have been little progression of it since that time.

During World War 2, when New Zealand’s access to many drugs and conventional medicines was under threat, much ground-breaking and valuable research was undertaken into the phytochemistry and bioactivities of many of our indigenous flora and fauna. With our hospitals now close to bursting, not to mention an alarming global increase in antibiotic resistance, the time has now come for policy makers, health funding providers, other health professionals and politicians, to again cast their attention to the enormous contribution that herbal medicine can make to our current and future healthcare services.

Herbal Medicines: Organic Or Not?

I’ve heard much discussion lately about how important Organic certification is for herbal medicines, and feel it’s appropriate to contribute my 2 cents worth.

The Oxford Dictionary defines ‘Organic’ in relation to food or farming as being ”produced or involving production without the use of chemical fertilisers, pesticides, or other artificial chemicals”.  Most organic certification agencies today extend this definition to exclude products made involving genetic modification (GMO’s).

Echinacea bumble bee

Humans have applied natural compounds and simple chemicals such as copper sulphate and lime as pest control methods in agriculture for a long time, but the use of synthetic pesticides accelerated in the 1940’s with the development of organochlorines such as DDT, aldrin, dieldrin, chlordane, parathion, and 2,4-5-T. Usage of agrichemicals to improve productivity and profits has been the norm for most types of farming ever since. Today a whole host of different synthetic chemicals are used in modern horticulture, ranging from fertilisers to herbicides to fungicides to insecticides to plant growth regulators.

Widespread and global contamination of the environment with organochlorines has occurred, and pesticide residues are now detectable in virtually all wildlife, well water, food and in humans. The long term effects of such compounds on the environment as well as human and plant health are unknown, as are those of residues of chemicals such as antibiotics and bovine growth hormones found in consumer products such as meat or milk. What is known, is that pesticides can have significant chronic health effects, including but not limited to cancer, neurological effects, diabetes, respiratory diseases, fetal diseases, hormone disruption and genetic disorders.

biogro standard 2009Most medicinal herbs are grown in developing countries, where programmes to control exposures to agrichemicals are either limited or non-existent. Many agrichemicals are toxic to handle, and pose significant risks, particularly in the event of accidental spills or inhalations. Children are particularly vulnerable to their harmful effects, with even very low levels of exposure during development potentially having adverse health effects. The World Health Organisation estimates that there are 3 million cases of pesticide poisoning each year and up to 220,000 deaths, primarily in developing countries.

Apart from the direct impact on humans, insects or animals who consume plant extracts either as foods or medicines which contain synthetic and potentially harmful chemicals, the effects that usage of chemical agents in agriculture have on the health of the planet’s bees, soils, waterways, and air, are of great concern.

The impact of farming practices on soil health is poorly understood, although soil samples from conventional farming generally contain higher levels of organochlorine pesticide residues compared to organic farming(1). The importance to soil health of diversity within the bacterial and fungal communities living within the soil, is becoming increasingly recognised, and this is greater under fully organic crop management(2,3).

The link between neonicotinoid pesticides and Colony Collapse Disorder in bees has been acknowledged by regulators in many countries, but took many years to happen. Also they remain in widespread use in some countries, despite potentially posing a serious threat to the world’s bee population upon which much of agriculture is dependent.

Given these adverse effects, and the absence of long term data in support of many new compounds being 100% safe, it is little wonder that consumer appetite for the use of synthetic and chemical-based pesticides continues to wane. While to date this trend towards organics seems to mainly apply to foods, given that most users of herbal medicines are taking them to optimise their health including to help counteract the effects of harmful environmental exposures, it would seem highly appropriate for there to be a preference for certified organic rather than non-organic herbal remedies.

 

Refs:

  1. Witczak A, Abdel-Gawad H. J Environ Sci Health B. 2012; 47(4):343-354.
  2. Reilly K et al, J Sci Food Agric 2013; 93(15):3700-9.
  3. Verbruggen E, Toby Kiers E. Evol Appl 2010; 3(5-6):547-560.

Farming plants rather than animals

My prime motivation in starting this blog, was and remains to espouse my enthusiasm for plants as medicines. However, some say food is the best form of medicine, and fruits, berries, vegetables and nuts (all from plants), are certainly healthy foods. Food availability and quality are also dependent on the condition of the soils and waterways where they are grown, as is human health related intrinsically to the health of the planet Earth.

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In 2016, environmental sustainability and climate change are critical issues facing humankind. A recent study by a formidable team of scientists suggests the impact of global warming will be quicker and more catastrophic than generally envisaged(1). The environmental effects of human agriculture, which contribute more than a quarter of all greenhouse gas emissions, therefore warrant more debate.

Growing evidence highlights the likely dual health and environmental benefits of reducing the proportion of animal-sourced foods in our diets(2). Recent evidence from large prospective US and European cohort studies and meta-analyses of epidemiological studies, shows an association of long-term consumption of substantial meat and particularly processed meat, with an increased risk of total mortality, cardiovascular disease, colorectal cancer and type 2 diabetes(3,4 ,5).

Two modelling studies published recently by sustainability researchers at Oxford University, now provide a compelling case that reducing red meat intake could also dramatically reduce greenhouse gas emissions and the rate of climate change(6,7).

The Oxford researchers used a region-specific global health model to analyse the environmental and health impacts of four dietary scenarios in the year 2050. A reference scenario was developed based on current projections from the UN Food and Agriculture Organisation (FAO). The second scenario, assumed the implementation of global dietary guidelines on healthy eating (the healthy global diet), and that people consume just enough calories to maintain a healthy body weight. The healthy global diet included a daily intake of at least five portions of fruits and vegetables, less than 50g of sugar, a maximum of 43g of red meat, and an energy content of 2,200-2,300 kcal. Other scenarios also assumed a healthy energy intake but were based on diets that were vegetarian (six portions of fruit and vegetables) or vegan (seven portions of fruits and vegetables, and one portion of pulses). For the first time, the Oxford team also attempted to estimate the economic value of different dietary choices, through their effects on health and the environment.

For the health analysis, they built a comparative risk assessment model to estimate age and region-specific mortality associated with changes in dietary and weight-related risk factors known to influence mortality in a dose-related manner. For the environmental analysis, they linked regional and scenario-specific food type consumption levels to greenhouse gas emissions. The economic analysis placed a monetary value on changes in greenhouse gas emissions by using estimates of the social cost of carbon and explored monetizing the health consequences using the value of statistical life, and projections of health-care expenditure by cause of death.

The findings from this analysis were that by 2050 less than half of all global regions are projected to meet dietary recommendations for the consumption of fruit, vegetables and red meat, and would also exceed the optimal total energy intake. To achieve the healthy global diet scenario, a 25% increase in global fruit and vegetable consumption would be required, moreso in Sub-Suharan Africa and South Asia. Global red meat consumption would need to decrease by 56%, and in Western high-income and middle-income countries, by a staggering 78% and 69% respectively.

The modelling study shows that moving to diets with fewer animal-sourced foods would have major health benefits, and reduce global mortality by 6-10%. Compared to the reference scenario, the authors projected that adoption of the healthy global dietary guidelines would avoid 5.1 million deaths per year, the vegetarian diet 7.3 million deaths a year, and the vegan diet 8.1 million deaths a year. More than half of these avoided deaths would be attributable to decreased red meat consumption, with 23-35% to increased fruit and vegetable consumption, and 19-30% to less over-eating. Shifting diets toward more plant-based and less animal-based foods, could reduce global mortality by 6-10% and food-related greenhouse gas emissions by 29-70% compared with a reference scenario in 2050. These benefits were calculated to be achievable even without any allowance for the beneficial impacts of dietary change on land use through avoided deforestation, meaning the theoretical reduction in greenhouse gases could be even higher.

The monetized value of adoption of the healthy global diet would also be comparable with, or exceed, the value of the environmental benefits. Overall, the economic benefits of improving diets were estimated to be 1-31 trillion US dollars, which is equivalent to 0.4-13% of global gross domestic product (GDP) in 2050.

In New Zealand, our animal-based agricultural sector is responsible for the bulk of our greenhouse gas emissions.  An estimated 80% of agricultural emissions of greenhouse gas arise from the livestock sector, in particular from ruminants such as cattle. One cow’s annual output of methane is about 100kg, equivalent apparently to the emissions generated by a car burning 890 litres of petrol, each year.

With growing concerns about the economic viability of the dairy industry even without any allowance for the many negative and historically under-estimated environmental impacts of its intensive model(8), it is time for a serious re-evaluation of New Zealand’s current agricultural sector.

However, food is both emotional and political, especially in agriculturally based economies such as New Zealand, where many have an unquestioning belief that red meat is a necessary dietary component, and that ‘more is good’. The negative reaction from the North American Meat Institute to the Oxford studies, is about as predictable as that of the American Rifleman’s Association to every attempt made to tighten gun laws there. Proponents of a largely vegetarian-based diet tend to gain more airtime in the U.K., but this has undoubtedly been catalysed by the Thatcher era mad cow disease scare, and the subsequent foot and mouth outbreak in 2001.

These types of regional differences and ingrained dietary and farming practices, will be no easy task to change, a fact acknowledged by Springmann and others(6,9). Clearly, massive political, industrial and cultural changes would be required to produce a 25% increase in fruit and vegetable consumption and 56% less meat consumption on a global level. Nevertheless, with climate change and the growing toll of diet-related premature deaths reaching crisis levels, it is time to seriously digest the growing amount of compelling research supporting horticulture as the basis of both foods and medicines. What we eat greatly influences our personal health and the environment we all share, and growing plants rather than farming methane-producing animals is a powerful way to mitigate climate change and to prevent many deaths.

Refs:

  1. Hansen James: https://www.aip.org/history/climate/impacts.htm
  2. Tilman D, Clark M Global diets link environmental sustainability and human health. Nature 2014; 515(7528):518-522.
  3. Battaglia Richi E et al, Health risks associated with meat consumption: A review of epidemiological studies. Int J Vitamin Nutr Res 2015; 85(1-2):70-78.
  4. Lippi G et al, Meat consumption and cancer risk: a critical review of published meta-analyses. Crit Rev Oncol Hematol 2016 Jan; 97:1-14.
  5. Wang X et al, Red and processed meat consumption and mortality: dose-response meta-analysis of prospective cohort studies. Public Health Nutr 2016 Apr; 19(5):893-905.
  6. Springmann M et al, Analysis and valuation of the health and climate change cobenefits of dietary change. Proc Natl Acad Sci USA 2016; Mar 21. pii:201523119 (epub ahead of print).
  7. Springmann M et al, Global and regional health effects of future food production under climate change: a modelling study. Lancet 2016 Mar 2. Pii:S0140-6736(15)01156-3.
  8. Foote KH et al, New Zealand Dairy Farming: Milking Our Environment for all its worth. Environ Manage 2015; 56(3):709-720.
  9. Marsh D. J Water resource management in New Zealand: jobs or algal blooms? Environ Manage 2012; 109:33-42.

Ligustrum lucidum – noxious weed or useful osteoporosis treatment?

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It’s a Saturday in early February in NZ, and the warm summer days linger on. Trying to retain some of the holiday vibe, we pack a picnic and togs and head out with some friends to Cornwallis Beach, on Auckland’s west coast.

On the way, as we drive up through Glen Eden and Titirangi, I find it difficult not to comment on the frequent appearance of Glossy Privet (Ligustrum lucidum) trees, on road and garden verges including an alarming number of indentations into adjacent native bush. Prominent this time of year with their creamy-yellow flower clusters amidst a dark green foliage background, they remind me of the Elder trees whose flowers used to similarly draw my attention every summer when I lived in the UK.

Unlike Elder in the UK, however, Glossy Privet is not native to New Zealand, and just like hundreds of other clever plant species, has become so well colonised here it is classed as a ‘noxious’ plant. It is, in fact, according to the NZ Plant Conservation Network(1), New Zealand’s most invasive introduced tree, as the dark purple brown berries make a tasty treat for our large bird population who then excrete the seeds far and wide. Not only around Auckland, but on a drive back from Gisborne to Auckland in January, I again couldn’t help but notice the large number of these trees in numerous locations throughout the 500km journey.

While my frequent comments concerning this tree to family or other fellow passengers over the past couple of years may seem obsessive, my fascination with it stems from the fact that it is also highly medicinal. In its native China, the small fruits of Glossy Privet (Nu-Zhen-Zi) are commonly used to strengthen bones, and it is an ingredient of many herbal formulae for the treatment of osteoporosis.  Osteoporosis is a condition characterised by low bone mass and micro-architectural deterioration of bone tissues leading to increased bone fragility. It is the leading cause of bone fractures in older adults, and is increasing in prevalence in both women and men, as populations age(2).

Several scientific papers have appeared in recent years supporting Glossy Privet’s beneficial effects in osteoporosis. These include increased circulation levels of vitamin D (1,25-dihydroxyvitamin D3) and improved calcium balance in mature female rats(3,4). Higher bone mineral density and positive effects on bone microstructure, have also been reported following its administration to young male and female growing rats(5-7). As optimising peak bone mass during early life is a key preventive action against osteoporosis, these findings collectively suggest that regular intake of Glossy Privet may well have a preventive effect against this debilitating condition in humans.

In Asian traditional medicine Glossy Privet is also used to treat menopausal problems, blurred vision, tinnitus, rheumatic pains, palpitations, backache and insomnia(8). Other traditional applications supported by recent scientific studies include protection against liver toxins(9, 10), and inhibition of the Hepatitis C (HCV) virus(11).

In China, as with other medicinal herbs, Glossy Privet fruits are sometimes used as an adjunct in cancer therapy (12). Researchers have reported enhanced sensitivity of human colorectal carcinoma cells to the chemotherapy drug doxorubicin(13). Inhibition of the mutagenic activities of benzo(a)pyrene(14) and aflatoxin B1(12) suggest cancer chemopreventive properties, and laboratory studies implicate potential applications in the treatment of human hepatocellular(15) and brain(16) cancer. Animal studies also suggest a possible therapeutic role in diabetes, including protective effects against diabetes-related reproductive deficits(9, 17, 18), and high fat diet-induced obesity(19).

There is clearly potential merit in further evaluating potential therapeutic applications of the fruits of this tree, now found throughout New Zealand and endemic in many other countries. Research to date strongly suggests a significant opportunity for medical herbalists and other clinicians, researchers, health funding providers and conservation agencies, to collaborate to further investigate such medicinal applications. Harvesting its berries and processing these into a prophylactic as well as treatment for osteoporosis alone, would reduce its spread and help protect New Zealand’s precious environment with less use of chemical control measures. This would at the same time also help to reduce Pharmac’s spending on biphosphonates and other osteoporosis treatments, thus potentially enabling more funding towards expensive new generation cancer drugs.

Refs:

  1. New Zealand Plant Conservation Network, www.nzpcn.org.nz
  2. Cawthon PM et al, Ther Adv Musculoskelet Dis 2016; 8(1):15-27
  3. Zhang YZ et al, J Econ Entomol. 2008;101(4):1146-51.
  4. Dong Xl et al, Menopause. 2010;17(6):1174-81.
  5. Feng X et al, Calcif Tissue Int. 2014; 94(4):433-41.
  6. Lyu Y et al, J Bone Miner Metab 2014; 32(6):616-626.
  7. Rasmussen PL, Phytonews 40, ISSN 1175-0251, Phytomed Medicinal Herbs Ltd, November 2014.
  8. Gao L et al, Nat Prod Res 2015; 29(6):493-510.
  9. Yim TK et al, Phytother Res 2001; 15(7):589-592.
  10. Gao D et al, Phytother Res 2009; 23(9):1257-1262.
  11. Kong L et al, Antiviral Res 2013; 98(1):44-53.
  12. Wong BY et al, Mutat Res 1992; 279(3):209-216.
  13. Zhang JF et al, Integr Cancer Ther 2011; 10(1):85-91.
  14. Niikawa M et al, Mutat Res 1993; 319(1):1-9.
  15. Hu B et al, Oncol Rep 2014; 32(3):1037-1042.
  16. Jeong JC et al, Phytother Res 2011; 25(3):429-434.
  17. Feng SL et al, Asian J Androl 2001; 3(1):71-73
  18. Zhang Y et al, J Ethnopharmacol 2014; 158, PtA:239-245.
  19. Liu Q et al, Nat Prod Commun 2014; 9(10):1399-1401

Herbal Medicine Past and Future

Herbal medicine or the use of plants as medicines, is the oldest form of medicine in the world. If the history of all human medicine was condensed into a relative 1 year timeframe, use of drugs (individual chemical entities) as primary medicine for health ailments has only been around for the past 2 minutes, herbs for the past 364 days and 58 minutes.

P1060966Known as Phytotherapy in Europe (‘phyto’ being the latin word for plant), and Botanical medicine in North America, the use of aerial parts, leaves, flowers, seeds, roots and barks of small (‘herbaceous’) plants, trees or mushrooms (fungi) to alleviate and prevent health complaints in humans and animals, is still the most often used medicine globally. Plants produce a large number of diverse chemicals (phytochemicals) to enable them to survive in their particular environment, just as human physiology has evolved to develop a wide range of biochemical compounds to help us cope with the many challenges of daily life. These phytochemicals help the plant cope with the stresses of drought, pest infestation, predator attack, nutritional deficits and much more. It is therefore not surprising that when taken in a balanced or whole plant part form by humans, they can help enhance our resistance to a range of illnesses.

Use of food as medicine is a growing trend in modern societies, and with the proliferation of so called ‘functional foods’ and ‘dietary supplements’ including capsules or tablets containing well known foods such as beetroot, garlic and turmeric, whether a particular product is in fact a food or a medicine or both, is often a challenge for consumers and regulators.

These hazy boundaries between foods and herbal medicines, reinforce the fact that not only is herbal medicine the most natural, accessible, safest and most easily assimilated form of medicine available, but also that as with a healthy plant-rich diet, it has a huge illness preventive potential. Preventative actions against a wide range of serious and increasingly common medical conditions have been shown from a growing body of research published in peer-reviewed scientific journals. Not only can a healthier diet have a major impact on health outcomes and the cost of modern day healthcare, but so too can prophylactic herbal medicine.

This simple fact, is something that should be properly digested by doctors, pharmacists and other healthcare professionals, as well as insurers, health policy analysts and politicians. The pharmaco-economics of a largely drug and hospital care-based health service is becoming increasingly expensive and unaffordable, and government efforts to encourage more ‘self-care’ by its population, should be cautiously congratulated. It is, however, a shame that due to a lack of recognition of the now compelling case for herbal medicine’s usefulness for a wide variety of common conditions, drugs continue to be used as a ‘first line’ therapy by much of the population, with resulting outcomes that are sometimes less than optimal. Limitations exist with many drug-focussed treatments in psychiatry, autoimmune diseases and cancer, and the increasing proliferation of ‘superbugs’ for which antibiotics and antiviral drugs are ineffective, is cause for alarm.

Apart from favourable clinical trial results, growing concerns about drug adverse effects and costs, aging populations and more emphasis on wellness and disease preventive approaches, have seen herbal medicine’s popularity grow substantially in recent years. As a country, New Zealand is extremely well positioned to take advantage of this global trend, and has an ability to grow, process, and manufacture, a wide range of herbal medicines. Our unique combination of geographical, soil and climatic attributes enables us to grow plants that are premium quality, something the world outside of New Zealand is increasingly appreciative of.  This combined with our agriscientific know how, health research capabilities and innovative food & beverage industry sectors, provides the potential to apply our greatest asset (that we are an ideal country to grow things in), to producing herbal medicines that are among the best quality in the world. This would make a valuable and cost-effective contribution to the health of our population, and that of other countries through development of a sizeable export industry.

Echinacea FieldHorticulture has much more long term potential to provide a sustainable and profitable return on agricultural investment than the dairy industry, and it is encouraging to see that fruit exports increased by 20% to reach $2 billion in the year ending June 2015 (www.stats.govt.nz). The fact that organically grown and processed products better care for the health of agricultural workers and our precious soil and environment, have optimal beneficial effects on end users, and attain a premium in export markets, is however, largely unrecognised. It is a shameful reflection on our farming practices and policies that New Zealand is trailing other countries in terms of the percentage of agricultural land that is certified organic.

The virtual absence of appropriate regulations for the local natural health product industry, and ongoing delays with their introduction, is also of concern. As with other export-focussed agricultural sectors of our economy, in order to achieve further establishment of a world class reputation, a regulatory environment that is current best practice and internationally recognised, is absolutely imperative.

Phil dispensingFinally, the obvious fact that as with drugs certain herbs may not be safe when made readily available for consumers to purchase and self-medicate with, should be better recognised by both consumers and regulators. A small number of herbs should therefore only be prescribed by well-trained medical herbalists following an individual consultation where they can make a valuable contribution to treatment, in a similar manner to drugs which can only be prescribed by medical specialists or suitably qualified health professionals.

It is clear that in this rapidly changing world herbal medicine has a huge potential to play a major role in the future health as well as economic and environmental wellbeing of New Zealanders. However, as with other industry sectors that have proven successful for our country in recent decades, this potential will take longer to develop or not be fully achieved, unless government takes an integrative, forward thinking and strategic approach to their policy setting and dealings with the industry, to help foster its further fruition.

Phil Rasmussen