Nature is our world’s oldest medicine. Herbal products and natural remedies are a significant part of various cultures and their healing traditions. Many people believe that these products, such as flowers, spices, oils, vitamins, and minerals, are deemed safe because they are considered “natural.” Conversely, herbal medicines can have harmful side effects, such as toxicity, over-dosing, herb contamination, and drug, food, and herbal interactions (Welz et al., 2018). Farazei et al. (2020) studied various herbal plants that can cause toxicity to further stress to providers the importance of using caution when utilizing herbal medicines in their patient care. My hospital has a significant pharmaceutical residency program who completes each admissions medication reconciliation. This is such a great resource for us as they preform a much more comprehensive assessment, including herbal and over-the-counter medication, in addition to have a detailed knowledge of pharmaceuticals. Additionally, as my patients bedside nurse, I often look over their medication and discuss it with them at administration.
Not regulated by the Federal Drug Association (FDA), botanicals lack “quality assurance along the distribution chain from growing and harvesting conditions to the end consumer products” (Linquist et al., 2018). Due to this poor quality control, herbal medicine has been found to be contaminated, contain substitutes and fillers, and not authentic. To tackle this issue, DNA barcoding has been utilized as a recent approach to better regulate herbal medicine for quality control (Ichim et al., 2020). DNA barcoding identifies genetic sequences to assess the composition of herbal medicines and further verify the labeled ingredients (de Boer et al., 2015). Newsmaster et al., (2013) applied DNA barcoding on various herbs to assess authenticity, contamination, substitution, and filler. Their study supports the use of barcoding to test content variability and active ingredient level consistency (Newsmaster et al., 2013). Dr. Stevenson, Ph.D., Cullman Curator and Vice President for Botanical Research, further supports proper testing and labeling through DNA barcoding as “the issues at stake include not only accurate information for the consumer but also potentially adverse effects from unwittingly consuming a plant species” (Swanson, 2015).
Echinacea and Ginkgo are two herbal medicines that I would consider using in my practice as they are already quite common and have fewer side effects than others. Echinacea is commonly used in the United States to prevent the common cold due to its believe “immunostimulatory effects” (Lindquist et al., 2018, p. 345). As our elderly population is expanding so does cognitive impairment. In various European studied and clinical trials, ginkgo demonstrated effective in reducing or reversing dementia (Lindquist et al., 2018, p. 347). Even with their low safety profiles, I would practice on the edge of caution with herbal supplements after learning their regulation issues.
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